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Groups that often require closer attention include: People following vegan diets or highly restrictive vegetarian diets Adults over age 50 who may absorb food-bound vitamin B12 less efficiently People who have had gastrointestinal surgery People with pernicious anemia or other conditions that impair absorption People using metformin or acid-suppressing medicines for prolonged periods Pregnant or breastfeeding people whose diets contain little or no animal-derived food Fatigue, numbness, balance problems, cognitive changes and anemia can have many causes

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The literature review supports that it is possible the primary oral melanoma (POM) is followed by a benign flat pigmented lesion by variable times (17-19)