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Eliminating all possible local sources of irritation and ruling out other causative factors are the standard first step in the treatment of oral melanoacanthoma. Conclusions This case shows the importance of including oral melanoacanthoma in the differential diagnosis of diffuse gingival pigmented lesions.A 47-year-old nulliparous, virginal woman presented to the emergency department with acute abdominal pain. Emergency pelvic ultrasound and abdominal CT were taken, which showed a significant amount of hemoperitoneum and a bicornuate uterus with abo