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Table 1 Conditions associated with mucosal pigmentation that should be considered during the differential diagnosis of oral melanosis [1, 6, 25,26,27]

From: Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib

Environmental causes  
 Smoking-associated melanosis  
 Heavy metal pigmentation due to metallic deposit  
 Dental amalgam tattoos  
 Drug-induced pigmentation  
Physiological causes  
 Physiological ethnic and/or racial pigmentation  
 Labial melanotic macule  
 Oral melanocytic nevi  
Pathological causes  
 Post-inflammatory deposits of melanin  
 Peutz–Jeghers syndrome  
 AIDS  
 Hemochromatosis  
 Addison’s disease  
 Laugier–Hunziker disease  
 Oral melanoacanthoma  
 Pseudo-ochronosis  
 Bandler’s syndrome  
 McCune–Albright syndrome  
 Cowden syndrome  
 Neurofibromatosis  
 Riehl’s melanosis  
 LAMB syndrome (Carney complex)  
 Polyostotic fibrous dysplasia syndrome  
 LEOPARD syndrome  
 Hyperthyroidism  
 Nelson’s syndrome  
 Melanosis associated with melanoma