Differential Diagnosis for Black Lesion over Soft Palate

• Single most likely diagnosis
  • Malignant melanoma: This is a likely diagnosis given the presence of multiple black lesions in different areas of the body, including the soft palate, temporal area, and chest. Melanoma can metastasize to various sites, and the oral cavity is a common location for metastasis.
• Other Likely diagnoses
  • Kaposi's sarcoma: This is a type of cancer that can cause black lesions, especially in immunocompromised individuals. It can affect the oral cavity, skin, and other organs.
  • Pigmented basal cell carcinoma: Although less common, basal cell carcinoma can present with pigmentation, and the presence of multiple lesions could suggest a more aggressive form of the disease.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Metastatic melanoma from an unknown primary: It is crucial to rule out the possibility of metastasis from an unknown primary melanoma site, as this would significantly impact treatment and prognosis.
  • Angiosarcoma: This rare and aggressive cancer can present with black lesions, especially in the head and neck region, and has a poor prognosis if left untreated.
• Rare diagnoses
  • Peutz-Jeghers syndrome: This genetic disorder is characterized by the presence of multiple pigmented lesions in the oral cavity and skin, but it is typically associated with gastrointestinal polyps and other systemic features.
  • Ephelides (freckles): Although benign, multiple freckles could be considered in the differential diagnosis, especially if the lesions are smaller and more numerous. However, the presence of larger, more prominent lesions makes this diagnosis less likely.