immune upregulation. for generalized and systemic cases chemotherapeutic drugs are used. haart is also a recognised treatment if the patient is known to have aids-related kaposi sarcoma. for cases of iatrogenic kaposi sarcoma any immunosuppressive medication should be stopped or reduced if able. smoker's melanosis smokers melanosis may resolve over several years following smoking cessation. oral melanoma an initial biopsy of the lesion may be carried out first to determine correct diagnosis. following this there is a number of different treatment options available. the combination used will be based on the individual patient and presenting melanoma. surgical resection is most commonly carried out. this involves cutting out the lesion and ensuring complete removal from the oral cavity. chemotherapy and radiotherapy are considered first line management and they may be used in conjunction with surgery. another option available is immunotherapy. the aim of this is to target cells or molecules in the immune system in an effort to destroy tumours. this can be done by suppressing or stimulating the patients immune system. after treatment has been carried out patients should be seen for regular follow ups to manage any reoccurrence early and ensure complete healing following surgeries. if the melanoma has progressed extensively and metastasised, treatment, for example surgery, would be carried out in a palliative nature only. epidemiology oral pigmentation also be classified as 2 categories, melanocytic or non-melanocytic. (melanocytic being the genesis due to the increase in melanotic pigments and non-melanocytic origin being the genesis from non melanotic causes). the prevalence of melanocytic and non-melanocytic causes of oral melanosis was roughly 1:1. physiological oral pigmentation affects about 3% of the population and is most likely seen in those with dark skin peutz jeghers syndrome for peutz jeghers syndrome the frequency is approximately 1 case per 60,000-300,000 people in the usa. equal occurrence in both sexes and all races. average age of diagnosis being 23 years in men and 26 years in women. smokers melanosis smoker's melanosis is present in all age groups, has no observed sex or race predilection. melanotic macule for hyperplastic or neoplastic processes, the mean age of oral melanotic macule (hyperplastic- increase in malanoticpigments without an increase in malanocytes) is 43.1 years with the mean size of the lesion was about 6.8mm. the female: male ratio is 2:1 and lower lip being the most common location. for oral melanoma (neoplastic) the mean age was 53.8 years with equal ratio of female:male and most common location being in the palate or gingiva. oral melanoma for oral melanoma (neoplastic lesion), the mean age was 53.8 years with equal ratio of female:male and most common location being in the palate or gingiva. cumulative frequency the occurrence of oral malanosis on the cheeks were (21%), alveolar mucosa (16.6%), gingiva (11.8%). amalgam tattoo being majority of the cases (46.3%), malanotic macules (22.9%) and nevus (20.5%).