Background. Mucosal melanotic lesions are rare, and the still rarer balloon cell variant has not been reported in the upper aerodigestive tract mucosa. We report a case of balloon cell nevus of the pharynx. Methods. A 35-year-old woman was seen with complaints of a black color in her mouth. Physical examination revealed a diffusely pigmented posterior pharyngeal wall. The pigmentation extended superiorly to the posterior edge of the palate, and laterally, it stopped short of the posterior tonsiliar pillars. The overlying mucosa was smooth, with no swelling. Flexible endoscopy showed that the lesion extended to the cricopharynx. Findings on histopathologic examination were consistent with balloon cell nevus of the pharynx. Complete excision was not possible, because the lesion was very diffuse. Results. After 2 years of conservative management and regular follow-up examinations, no change in the symptoms and no increase in the lesion have been seen. Conclusion. Melanotic lesions in the upper aerodigestive tract mucosa are rare. This case is reported for its rarity, unusual presentation, and characteristic histopathologic features.
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