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Pathological oral mucosal melanin hyperpigmentations include those related to tobacco smoke, to certain systemic diseases or syndromes, to inflammatory processes, to certain drugs, and to developmental, benign, or malignant changes in melanocytes [4, 6, 1013]

A, Irregular lentiginous epidermal hyperplasia with solitary melanocytes distributed asymmetrically at the dermal-epidermal junction and no dermal nests (hematoxylin-eosin, original magnification 40)

When ACD is suspected, testing should include both DHA (if available) and commonly implicated ingredients

It is highly unlikely to see any visible tanning results in the first week