Background: The main etiologic factor responsible for melanocytic pigmentation of the oral mucosa in the white population is cigarette smoking. In his 1977 report, Hedin coined the term smoker's melanosis to describe this clinical condition.

Pathophysiology: Smoker's melanosis may be due to the effects of nicotine (a polycyclic compound) on melanocytes located along the basal cells of the lining epithelium of the oral mucosa. Nicotine appears to directly stimulate melanocytes to produce more melanosomes, which results in increased deposition of melanin pigment as basilar melanosis with varying amounts of melanin incontinence.

Frequency:

Mortality/Morbidity: Smoker's melanosis is not associated with mortality or morbidity.

Race: This condition is most evident in whites because of a lack of physiologic pigmentation in the oral mucosa of this population, but some dark-skinned individuals who smoke will have more prominent pigmentation in many oral sites.

Sex: Females are affected more than males, which may be explained by the additive effects of estrogen in female smokers. Increases in estrogen levels observed during pregnancy and the use of birth control pills are linked to other hyperpigmentation conditions (eg, melasma).

Age: The incidence of smoker's melanosis increases with age, suggesting that the longer a person smokes, the more likely he or she will develop the condition.

History: No symptoms are associated with this condition. A smoking history is needed to substantiate the diagnosis.

Physical: Smoker's melanosis is a brownish discoloration of the oral mucosa. In cigarette smokers, most lesions are located on the mandibular anterior gingiva. Pipe smokers more frequently display pigmentation of the buccal mucosa. In people who engage in reverse smoking (ie, the lit end of a cigarette placed in the oral cavity), pigmentation of the hard palate is common.

Causes: This condition is likely due to direct effects of tobacco smoke on the oral mucosa. Smoke is thought to cause changes in the mucosa through a combination of physical (heat) and/or chemical (nicotine) effects. Individuals using smokeless tobacco or nicotine-containing gum do not develop this condition.

Medical Care: Smoking cessation is indicated for a multitude of health reasons. Cessation usually results in gradual disappearance of the melanosis over a period of several years.

Consultations: Smoking cessation programs with counselors or behavior modification specialists may be beneficial.