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Oral melanotic macule - Oral Mucosal Lesion
Other Resources UpToDate PubMed

Oral melanotic macule - Oral Mucosal Lesion

Contributors: Jeffrey M. Cohen MD, Sook-Bin Woo MS, DMD, MMSc, Carl Allen DDS, MSD, Susan Burgin MD
Other Resources UpToDate PubMed


An oral melanotic macule is a benign hyperpigmented macule that may be found on the lips or oral mucosa in approximately 3% of the general population. It is caused by an increase in focal melanin deposition that is occasionally associated with an increased number of melanocytes.

Melanotic macules are most commonly found on the vermillion border of the lip, lower more often than upper. Lesions can also be found on the gingiva or palate, and they may be multiple. Some experts refer to lip lesions as labial melanotic macules, although histopathology is identical to that at any other mucosal site.

Oral melanotic macules are common in individuals with darker skin colors and are seen more frequently in women than men. The average age at time of presentation is approximately 40 years, although these macules may appear at any age. In patients with darker skin colors, onset typically occurs in adolescence. Lesions on the lips are generally diagnosed earlier than those in the intraoral mucosa.


K13.79 – Other lesions of oral mucosa

235041006 – Oral melanocytic macule

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Differential Diagnosis & Pitfalls

  • Amalgam tattoo (exogenous pigmentation) – This is the most common intraoral pigmented lesion. Usually the amalgam tattoo is not elevated, and particles of dental amalgam (silver filling material) can often be detected on periapical radiographs of the lesional site.
  • Physiologic pigmentation – This presents as macular hyperpigmentation of the oral mucosa. Areas of hyperpigmentation vary in shape and size, and this is most common among darker-skinned individuals.
  • Oral melanoacanthoma – This uncommon condition occurs most frequently in young adult Black women, typically on the buccal mucosa. The lesion is generally much larger (1 cm or greater) than a melanocytic nevus, and it often follows a characteristic pattern of spontaneous involution over a period of days to weeks.
  • Melanoma (primary or metastatic) – Both primary and metastatic melanoma are rarely seen intraorally. Within the oral cavity, melanoma is most prevalent on the palate.
  • Common acquired nevus or Blue nevus
  • Oral varices (Venous lake) is a common lesion on the lower vermilion, but this tends to be a papule or bleb that blanches if pressure is applied to it. It also tends to occur in older adults.
  • Smoker's melanosis tends to be located on the anterior mandibular buccal attached gingiva in a bilaterally symmetric distribution.
  • Peutz-Jeghers syndrome
  • Carney complex
  • Multiple lentigines syndrome
  • Drug-induced pigmentation / Drug-induced oral pigmentation (eg, antimalarials, tetracyclines, some chemotherapeutic agents)
  • Heavy metal poisoning (see Arsenic poisoning, Lead poisoning, Mercury poisoning, Thallium poisoning)
  • Addison disease
  • AIDS-associated Kaposi sarcoma
  • Hematoma
  • McCune-Albright syndrome
  • Laugier-Hunziker syndrome

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Last Reviewed:01/09/2022
Last Updated:02/09/2022
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Patient Information for Oral melanotic macule - Oral Mucosal Lesion
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Oral melanotic macule - Oral Mucosal Lesion
A medical illustration showing key findings of Oral melanotic macule : Lips, Oral brown macule, Oral mucosa
Clinical image of Oral melanotic macule - imageId=175614. Click to open in gallery.  caption: 'A brown macule on the lower lip.'
A brown macule on the lower lip.
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