Oral Hemorrhagic Lesion Mimicking Melanoma: A Case Report of Severe Thrombocytopenia with Suspected Immune Thrombocytopenic Purpura

Abstract

Oral pigmented and hemorrhagic lesions frequently pose a diagnostic challenge because of their broad differential diagnosis, including benign, vascular, hematological, and malignant conditions. Oral melanoma, although uncommon, remains a clinically significant concern owing to its aggressive nature and poor prognosis. Conversely, hematological disorders such as immune thrombocytopenic purpura (ITP) may present with hemorrhagic lesions that resemble pigmented neoplasms. We report the case of a 22-year-old male presenting with a sudden-onset dark intraoral swelling involving the posterior buccal mucosa. Clinical examination initially raised suspicion of an oral pigmented lesion, including melanoma in the differential diagnosis. Hematological investigations demonstrated severe thrombocytopenia with a platelet count of 12 × 10⁹/L, neutrophilic leukocytosis, and peripheral smear findings suggestive of marked thrombocytopenia. Correlation of clinical and laboratory findings favored a diagnosis of severe thrombocytopenia with oral hemorrhagic manifestation, clinically consistent with suspected immune thrombocytopenic purpura. The patient was managed conservatively with corticosteroid and supportive therapy, resulting in gradual regression of the lesion. This case emphasizes the importance of thorough systemic evaluation and hematological assessment before undertaking invasive procedures in patients presenting with oral hemorrhagic or pigmented lesions.