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In addition, cells are not completely defenceless, as they are able to deploy a range of antioxidant enzymes to counteract ROS (see Figure 1)

The exact cause is unclear, but the textbooks describe several recognised contributors: Focal increase in melanin within the basal layer (the deepest, foundation layer of the mouth lining) of the lining, with or without an increase in the number of melanocytes (the cells that make melanin)

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