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Some other oral lumps, bumps and colour changes
• Mucocoeles are collections of mucin following the rupture of a minor salivary gland duct. They are blue-tinted soft translucent nodules, usually of the lips, and arise suddenly without pain.
• Fordyce spots are ectopic sebaceous glands, appear-ing as pinhead-sized whitish-yellow papules on the labial mucosa (Fig. 13.34).
• Yellow patches in the mouth may suggest pseudox-anthoma elasticum.
• Brown macules on the lips should trigger thoughts about the dominantly inherited Peutz–Jehgers syn-drome (Fig. 17.12) and its bowel polyps and tumours.
Neurofibromas may occur, especially in patients with widespread cutaneous neurofibromatosis.
• Telangiectases may suggest hereditary haemorrhagic telangiectasia. These patients may also have telangiec-tases in their intestinal tract leading to gastrointestinal bleeding, and arteriovenous fistulae especially in the lungs that may lead to cerebral embolism.
• Venous lakes are blue or black papules on the lips (Fig. 13.35). These melanoma-like lesions worry pati-ents and doctors alike, but pressure with a diascope or glass slide causes them to blanch.
• Multiple, somewhat translucent, papules may suggest Cowden’s syndrome. These are fibromas. Patients with Cowden’s syndrome have facial papules and nodules (tricholemmomas and fibromas), fibrocystic disease of the breasts and a great propensity to develop malig-nant tumours of the breast, thyroid and other organs.
• Patients with the multiple mucosal neuroma syn-drome have neuromas in their mouths, and 75% of those with this autosomal dominantly inherited dis-order also have medulary carcinoma of the thyroid. Many also develop pheochromocytomas. Many small bumps appear along the lips, tongue and buccal mucosae.
• Pyogenic granulomas of the gingiva appear as quick-growing red bleeding papules. They are reactive pro-liferations of blood vessels, and often develop in pregnancy (‘pregnancy tumours’).
• Fibromas may result from dentures, or from resolving or indolent pyogenic granulomas, but can also appear without reason, usually on the gingiva of adults. Tooth bites may cause fibromas to appear on the tongue and on the buccal mucosae. Cowden’s disease should be considered if multiple lesions are present.
• Warts in the mouth are not uncommon.
• The differential diagnosis of oral papules and nodules also includes lipomas, keloids, giant cell granulomas, granular cell tumours, myxomas, xanthomas, hae-mangiomas, myomas, neural tumours and a host of uncommon benign growths.
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