Oral melanoacanthoma is an uncommon reactive condition that appears as a solitary pigmented lesion and is most often found on the buccal mucosa. For it to appear in the gingiva is extremely rare—only 11 cases are reported in the literature. This article presents a case of gingival melanoacanthoma and reviews the previously published cases. Because gingival melanoacanthoma shares clinical features with other pigmented lesions with diverse genesis, the differential diagnosis of a solitary pigmented lesion on the gingiva is also discussed. (Quintessence Int 2011;42:253–258)

Key words: amalgam tattoo, gingiva, melanoacanthoma, melanoma, pigmented lesion, smoking- or drug-induced pigmentation