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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  
 Addison’s disease  
 Laugier–Hunziker disease  
 Oral melanoacanthoma  
 Bandler’s syndrome  
 McCune–Albright syndrome  
 Cowden syndrome  
 Riehl’s melanosis  
 LAMB syndrome (Carney complex)  
 Polyostotic fibrous dysplasia syndrome  
 LEOPARD syndrome  
 Nelson’s syndrome  
 Melanosis associated with melanoma