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.
§ figuresFigures (0)
Verified clinical image not yet available
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Melanotic Macule figures pending faculty review.
§ 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:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Neville BW. Oral & Maxillofacial Pathology, 4e
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.