BROWN HEME-ASSOCIATED LESIONS
Ecchymosis
Traumatic ecchymosis is common on the lips and face yet is uncommon in the oral mucosa. Immediately following the traumatic event, erythrocyte extravasation into the submucosa will appear as a bright red macule or as a swelling if a hematoma forms. The lesion will assume a brown coloration within a few days, after the hemoglobin is degraded to hemosiderin (Figure 6-11).
The differential diagnosis must include other focal pigmented lesions. If the patient recalls an episode of trauma, however, the lesion should be observed for 2 weeks, by which time it should have resolved if it represents a focus of ecchymosis.Ecchymosis
Traumatic ecchymosis is common on the lips and face yet is uncommon in the oral mucosa. Immediately following the traumatic event, erythrocyte extravasation into the submucosa will appear as a bright red macule or as a swelling if a hematoma forms. The lesion will assume a brown coloration within a few days, after the hemoglobin is degraded to hemosiderin (Figure 6-11).
When multiple brown macules or swellings are observed and ecchymosis is included in the differential diagnosis, a hemorrhagic diathesis should be considered. Certainly, patients taking anticoagulant drugs may present with oral ecchymosis, particularly on the cheek or tongue, either of which can be traumatized while chewing. Coagulopathic ecchymosis of the skin and oral mucosa may also be encountered in hereditary coagulopathic disorders and in chronic liver failure. A coagulation panel including prothrombin time and partial thromboplastin time should be ordered in instances of unprovoked ecchymoses to explore defects in the extrinsic and intrinsic pathways, respectively. The clotting time will also be prolonged.