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The most affected site is the gingiva, particularly the attached gingiva, excluding the marginal border [21,22], in 72% of cases of ethnic pigmentation [15] other affected sites include the buccal mucosa, lips, palate, and tongue (Figure 4) [16,19]
Once it is recommended that the cavalier be examined by echo, it is the best practice to have that exam performed only by a cardiologist or other heart specialist
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