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Oral melanotic macule - Oral Mucosal Lesion
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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.
  • 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.
  • Nevus or blue nevus
  • Varix (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
  • LEOPARD 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
  • 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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Contributors: Medical staff writer


Oral melanotic macule is a non-cancerous (benign), dark spot found on the lips or inside the mouth. An oral melanotic macule found on the lip is sometimes called a labial melanotic macule.

Who’s At Risk

Oral melanotic macules can appear in people of any age, of any race, and of either sex. However, they are more common in middle-aged people, in dark-skinned people, and in females.

Signs & Symptoms

The most common locations for an oral melanotic macule include:
  • Lips, especially the lower lip
  • Gums (gingiva)
  • Inner cheek (buccal mucosa)
  • Roof of the mouth (hard or soft palate)
An oral melanotic macule appears as a solitary, flat, tan-to-dark-brown spot usually less than 7 mm in diameter. It has a well-defined border and a uniform color.

People can have more than one oral melanotic macule.

Self-Care Guidelines

There are no self-care measures for oral melanotic macules.

When to Seek Medical Care

See your doctor for any new dark spot on the lips or inside the mouth. Similarly, any existing spot that changes size, shape, or color should also be evaluated promptly.


If the diagnosis of oral melanotic macule is not certain, your physician may wish to perform a skin biopsy in order to confirm the diagnosis. The procedure involves:
  1. Numbing the skin with an injectable anesthetic.
  2. Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a suture or two may be placed and will need to be removed 5-10 days later.
  3. Having the skin sample examined under a microscope by a specially trained physician (dermatopathologist).
Your doctor is more likely to biopsy certain lesions, such as new ones, large or growing ones, or those with irregular color (pigmentation). The biopsy can help the doctor to tell whether it is a benign oral melanotic macule or a malignant melanoma, a type of skin cancer.

Most dark spots on the lips or inside the mouth are benign oral melanotic macules. Usually, your doctor will observe the lesion by measuring it, by taking a photograph of it, or both. As long as the oral melanotic macule stays stable in size, shape, and color, no treatment is needed.

Nonetheless, some people want the lesion removed for cosmetic reasons. If it is appropriate, some physicians might recommend excision or, rarely, laser treatment.


Bolognia, Jean L., ed. Dermatology, pp.1094. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1083. New York: McGraw-Hill, 2003.
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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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