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Darkened alveolar bone with minocycline therapy (10% at 1 year, 20% at 4 years of therapy) Diagnosis History of exposure to, or ingestion of, heavy metals or drugs Differentiation from melanocyte-related pigmentation by biopsy if necessary Differential Diagnosis When localized: amalgam tattoo, mucosal melanotic macule, melanoacanthoma, mucosal nevus, ephelides, Kaposis sarcoma, purpura, malignant melanoma, ecchymosis When generalized: ethnic pigmentation, Addisons disease If asymmetric, in situ melanoma must be ruled out by biopsy

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NICE recommends continuing GLP-1 therapy only if HbA1c reduces by at least 11 mmol/mol and weight decreases by at least 3% at six months