Pigmented Lesions
Oral Melanotic Macule
aka Labial Melanotic Macule · Mucosal Melanosis
Benign, flat, well-circumscribed brown macule on oral mucosa due to increased melanin production without melanocyte proliferation.
§ overviewOverview
Focal area of increased melanin deposition in basal layer without increase in melanocyte number.
§ icdICD Classification
L81.4
§ etiologyEtiology
- 01Idiopathic
- 02Post-inflammatory
- 03Chronic irritation
§ epidemiologyEpidemiology
Most common pigmented lesion of oral cavity. Adults, F > M. Lower lip vermilion most common.
§ pathogenesisPathogenesis
Increased melanin production by existing melanocytes with pigment incontinence into lamina propria.
§ clinicalClinical Features
- 01Flat, brown to black macule
- 02Well-defined borders
- 03Usually <1 cm
- 04Non-elevated, non-palpable
§ differentialDifferential Diagnosis
- 01Amalgam tattoo
- 02Oral nevus
- 03Early melanoma
- 04Physiological pigmentation
§ histopathHistopathology
- 01Increased melanin in basal layer
- 02Melanophages in lamina propria
- 03Normal melanocyte count
§ investigationsInvestigations
- 01Biopsy if atypical features (irregular borders, rapid growth)
§ treatmentTreatment
- 01Observation if clinical diagnosis confident
- 02Excisional biopsy if doubt
§ prognosisPrognosis
Excellent; no malignant potential.
§ examKey Examination Points
- 01Flat, well-circumscribed, stable size
- 02Normal melanocyte number
- 03Biopsy if atypical
§ revisionQuick Revision Summary
- 01Most common oral pigmented lesion
- 02Increased melanin, not melanocytes
- 03Biopsy if suspicious
§ vivaBDS Viva Questions
- 01How do you differentiate from melanoma?
- 02What is the histology?
- 03When would you biopsy?
§ mcqsMCQs — Assessment (3)
Question 1
Oral melanotic macule shows:
Question 2
Most common site for oral melanotic macule:
Question 3
Management:
References
- Neville BW. Oral & Maxillofacial Pathology, 4e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.