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Background <p>Lenalidomide is an immunomodulatory agent widely used in the treatment of multiple myeloma and is generally associated with a favorable safety profile. Although pigmentary alterations such as cutaneous hyperpigmentation and hair repigmentation have been reported, oral mucosal involvement remains poorly documented. </p> Case presentation <p>An 80-year-old Black female with multiple myeloma undergoing lenalidomide therapy presented with asymptomatic brown macules on the tongue, hard palate, bilateral buccal mucosa and gingiva. Histopathological examination of an incisional biopsy on the tongue revealed many fine granular, brownish pigmentation of approximately the same size throughout all epithelial layers, as well as collagen fibers, vascular walls, neural tissue, and skeletal striated muscle. These findings represent an unusual pattern of pigment distribution not previously described in patients under lenalidomide therapy. </p> Conclusion <p>This case emphasizes the need for thorough oral examination in patients undergoing lenalidomide therapy, as early recognition of drug-induced pigmentation is essential for proper diagnosis and management.</p>

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Lenalidomide-Associated Oral Pigmentation: A Case Report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月24日

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  • André Luis Santana de Freitas,
  • Fabiana Gomes Cardoso Pereira de Sousa,
  • Cleverson Teixeira Soares,
  • Rosane Rezende de Souza Giuliani,
  • Andresa Borges Soares

摘要

Background

Lenalidomide is an immunomodulatory agent widely used in the treatment of multiple myeloma and is generally associated with a favorable safety profile. Although pigmentary alterations such as cutaneous hyperpigmentation and hair repigmentation have been reported, oral mucosal involvement remains poorly documented.

Case presentation

An 80-year-old Black female with multiple myeloma undergoing lenalidomide therapy presented with asymptomatic brown macules on the tongue, hard palate, bilateral buccal mucosa and gingiva. Histopathological examination of an incisional biopsy on the tongue revealed many fine granular, brownish pigmentation of approximately the same size throughout all epithelial layers, as well as collagen fibers, vascular walls, neural tissue, and skeletal striated muscle. These findings represent an unusual pattern of pigment distribution not previously described in patients under lenalidomide therapy.

Conclusion

This case emphasizes the need for thorough oral examination in patients undergoing lenalidomide therapy, as early recognition of drug-induced pigmentation is essential for proper diagnosis and management.