they show up on x-rays),: 138  although in many cases, amalgam tattoos have no radiographic features since the responsible particle(s) of amalgam are very small even though clinically the area of discolored mucosa is much larger.If necessary, the diagnosis can be confirmed histologically by excisional biopsy, which excludes nevi and melanomas. : 138  If a biopsy is taken, the histopathologic appearance is:
Pigmented fragments of metal within connective tissue
Staining of reticulin fibers with silver salts
A scattered arrangement of large, dark, solid fragments or a fine, black or dark brown granules
Large particles may be surrounded by chronically inflamed fibrous tissue
Smaller particles surrounded by more significant inflammation, which may be granulomatous or a mixture of lymphocytes and plasma cells

Prevention
Theoretically, routine use of a dental dam during dental procedures which involve amalgam should reduce the risk of amalgam tattoo. Treatment
No treatment is required since the lesion is entirely benign. Some suggest that amalgam tattoos are best surgically excised so as to ensure the lesion does not represent a melanoma. : 138  Others say that excision should only be carried out if there is any doubt over the diagnosis, and that amalgam tattoos are managed by simple reassurance about the nature of the lesion. : 330  For example, if radio-opaque particles are demonstrated on the x-ray, biopsy is unnecessary. Epidemiology
Amalgam tattoo is found in up to 1% of people in the general population. It is the most common cause of solitary or focal pigmentation of the oral mucosa. Notes
References


== External links ==
Pes anserinus ("goose foot") refers to the conjoined tendons of three muscles of the thigh. It inserts onto the anteromedial (front and inside) surface of the proximal tibia. The muscles are the sartorius, gracilis and semitendinosus sometimes referred to as the guy ropes. The name "goose foot" arises from the three-pronged manner in which the conjoined tendon inserts onto the tibia. Structure
The three tendons, from front to back, that conjoin to form the pes anserinus come from the sartorius muscle, the gracilis muscle, and the semitendinosus muscle. It inserts onto the proximal anteromedial surface of the tibia.The pes anserinus is around 5 cm below the medial tibial joint line. It lies superficial to the tibial insertion of the medial collateral ligament of the knee. Clinical significance
Pes anserine bursitis is a cause of chronic knee pain and weakness. It occurs when the medial portion of the knee is inflamed. If the bursa underlying the tendons of the sartorius, gracilis, and semitendinosus gets irritated from overuse or injury, a person can develop this ailment. This condition usually occurs in athletes from overuse. This pathology is characterized by pain, swelling, and / or tenderness.The semitendinosus tendon can be used in certain techniques for reconstruction of the  anterior cruciate ligament. History
The name "goose foot" arises from the three-pronged manner in which the conjoined tendon inserts onto the tibia. Additional Images
References
External links
Pes anserinus at the Duke University Health Systems Orthopedics program