Association of oral mucosa hyperpigmentation with imatinib mesylate use: a cross-sectional study and a systematic literature review

  • Sicília Rezende Oliveira
  • Luciana Gravito de Azevedo Branco
  • Amanda Leal Rocha
  • Denise Vieira Travassos
  • Gustavo Henrique Romani Magalhães
  • Felipe Paiva Fonseca
  • Ricardo Alves Mesquita
  • Lucas Guimarães AbreuEmail author
  • Tarcília Aparecida da Silva
Original Article



To assess the association between oral mucosa hyperpigmentation in patients with leukemia and imatinib mesylate use. Additionally, we compared our data to those obtained from a systematic review.

Materials and methods

A cross-sectional study was conducted with 74 patients undergoing treatment with imatinib mesylate. Sociodemographic characteristics, oral mucosa alterations, and medical history were evaluated. Oral hyperpigmentation was scored. The use of imatinib mesylate and hydroxyurea was evaluated. Association between oral hyperpigmentation and imatinib mesylate was assessed. A systematic review was also conducted to retrieve case reports or case series of patients with oral hyperpigmentation associated with imatinib mesylate.


Among the 74 participants, 41 were male (55.4%) and 33 were female (44.6%). Participants’ mean age was 49.3 years. Sixty-six (89.2%) patients developed hyperpigmented lesions in the hard palate mucosa. In multivariate analysis, patients who had used imatinib mesylate for > 72 months had a hyperpigmentation score 1.62 times higher than those who had used this medication during a shorter period. Patients who had used hydroxyurea for > 30 days had a hyperpigmentation score 1.43 times higher than those who had used this medication during a shorter period. The systematic review retrieved 20 clinical cases of patients undergoing imatinib mesylate treatment and exhibiting oral hyperpigmentation.


The development of oral hyperpigmentation is associated with imatinib mesylate use. Hydroxyurea seems to increment such an association.

Clinical relevance

To assist providers in the differential diagnosis of hyperpigmented lesions associated with imatinib mesylate, as well as in the clinical management of such lesions.


Oral hyperpigmentation Imatinib mesylate Hydroxyurea Antineoplastic agents 


Funding information

This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-Finance code 001). RAM and TAS are research fellows of CNPq.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sicília Rezende Oliveira
    • 1
  • Luciana Gravito de Azevedo Branco
    • 1
  • Amanda Leal Rocha
    • 1
  • Denise Vieira Travassos
    • 2
  • Gustavo Henrique Romani Magalhães
    • 3
  • Felipe Paiva Fonseca
    • 1
  • Ricardo Alves Mesquita
    • 1
  • Lucas Guimarães Abreu
    • 4
    Email author
  • Tarcília Aparecida da Silva
    • 1
  1. 1.Department of Oral Pathology and Surgery, School of DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  2. 2.Department of Community and Preventive Dentistry, School of DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  3. 3.Department of Hematology and Oncology, Chronic Myeloproliferative Diseases Outpatient ClinicUniversidade Federal de Minas GeraisBelo HorizonteBrazil
  4. 4.Department of Pediatric Dentistry and Orthodontics, School of DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil

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