Finding a black spot inside your cheek can cause concern. While many such spots are harmless, understanding their potential origins can provide clarity. These discolorations often stem from benign factors, yet some may warrant medical attention.
Common Explanations for Black Spots
Many black spots inside the cheek are benign, stemming from common occurrences or natural variations. One frequent cause is an amalgam tattoo, appearing as a painless, bluish-gray or black, flat spot. These tattoos form when tiny particles from silver dental fillings become embedded in the soft tissues of the mouth, often during filling placement or removal. Amalgam tattoos are harmless and typically do not change in size or color, remaining permanently unless removed for cosmetic reasons.
Another common explanation is traumatic pigmentation, which can occur from minor injuries like accidentally biting the cheek. This trauma can lead to blood pooling under the surface, creating a temporary dark spot similar to a bruise. These spots usually resolve on their own as the tissue heals.
Oral melanotic macules, often described as oral “freckles” or moles, are another benign cause. These are flat, well-defined spots resulting from increased melanin production in the mucous membrane. While they can be brown, blue, or gray, they are not cancerous and do not increase cancer risk.
Physiological pigmentation refers to naturally darker patches in the mouth due to melanin, common in individuals with darker skin tones. These variations are normal and genetically determined, often appearing as uniform or speckled brown areas on various oral tissues.
When a Spot Warrants Medical Attention
While many black spots are harmless, certain characteristics or changes should prompt medical evaluation. A spot that changes in size, shape, or color, such as darkening or developing uneven pigmentation, needs professional assessment. Asymmetry, where one half of the spot does not match the other, or irregular borders, like jagged or blurred edges, are also concerning signs.
Any spot that becomes raised or lumpy, rather than remaining flat, should be examined by a healthcare provider. New symptoms, including pain, bleeding, itching, or tenderness associated with the spot, indicate a need for medical attention. A black spot that persists for more than a few weeks, especially without a clear cause like recent trauma, should be evaluated to rule out more serious underlying conditions.
Potential Underlying Conditions
Beyond common benign causes, black spots inside the cheek can rarely indicate more serious conditions. Oral melanoma is a very rare but aggressive form of cancer originating from pigment-producing cells. While most oral melanomas are asymptomatic in early stages, they can appear as dark brown to blue-black spots that may be flat or raised and often have irregular shapes and borders. Due to its rarity, vigilance is important if any suspicious changes occur.
Vascular lesions, such as hemangiomas, are another potential cause. These are benign growths of blood vessels that can appear dark or bluish due to blood collection within them. Hemangiomas are common benign tumors of infancy, often appearing within the first month of life and may involute over time. They can be found on the lips, tongue, or buccal mucosa and may range in size. Other rare possibilities include certain systemic conditions that can manifest with oral pigmentation.
The Diagnostic Journey
When a black spot inside the cheek raises concern, a healthcare professional will begin with a thorough medical history and oral examination. The doctor will inquire about the spot’s duration, any associated symptoms, and a patient’s overall health history, including tobacco or alcohol use. During the physical exam, the mouth is carefully inspected, and the doctor may feel for any lumps or swelling in the cheeks, lips, tongue, and neck.
If the spot appears suspicious, a biopsy is often necessary to confirm a diagnosis. This procedure involves taking a small tissue sample for microscopic examination by a pathologist. A biopsy is the only definitive way to determine if cancer cells are present. Depending on the findings, a general practitioner or dentist may refer the patient to a specialist, such as an oral surgeon or dermatologist, for further evaluation or treatment. Early detection and professional assessment are crucial to ensure timely intervention if a serious condition is identified.