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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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Research examines its signaling effects without significant impact on cortisol or prolactin

This migration is closely related to cytoskeleton remodeling, particularly involving the protein actin

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