Differentiating Melanoplakia from Oral Malignant Melanoma

Key Clinical Distinguishing Features

The British Medical Journal recommends that any change in size, shape, or color of a lesion should prompt further investigation, as these are major signs of potential melanoma 1
The presence of inflammation, sensory change, crusting, oozing, or bleeding, and a diameter of ≥7 mm are minor signs that strengthen suspicion of melanoma when combined with major signs, according to the British Medical Journal 1
The British Journal of Cancer suggests that a change in shape, such as irregular borders developing, and a change in color, such as heterogeneous pigmentation with multiple shades of brown/black, are indicative of melanoma 3

The British Medical Journal advises that if any major signs are present, such as change in size, shape, or color, an excisional biopsy should be performed immediately 1
The British Journal of Cancer recommends that complete excisional biopsy with 2 mm margins is the standard for definitive diagnosis, and that histopathology must include melanocytic nature confirmation, malignancy assessment, and other factors 3

The British Medical Journal warns against relying on pigmentation alone for diagnosis, as amelanotic melanomas exist and typically show peripheral pigment rim with central nodularity 1
The British Journal of Cancer advises against performing frozen sections, as these compromise diagnostic accuracy for melanocytic lesions 3

The British Journal of Cancer recommends that complete skin and oral cavity examination is mandatory to detect synchronous primary melanomas 3
The Praxis Medical Insights guideline suggests that in smoking patients with confirmed smoker's melanosis, counseling on cessation is recommended as pigmentation may regress, and that a complete excisional biopsy with 2 mm margins is the standard for definitive diagnosis 2