These benign, ephelis-like pigmented macules are the most common melanocytic lesions of the oral mucosa. They are brownish-blue or black and may be single or multiple. They are typically well defined and rarely exceed 6 mm in diameter. They develop during early to middle adult life with a mean age at presentation of 41 years . There is a female predilection of 2:1. They are most frequent in the anterior part of the mouth affecting the gingiva, buccal mucosa and, most commonly, the labial mucosa. Those involving the vermilion border (labial melanotic macules) often darken in strong sunlight and may cause cosmetic problems. Oral melanotic macules have been reported following radiotherapy ,
and in HIV infections, probably related to the administration of retroviral drugs .
Microscopy shows increased melanotic pigmentation in the basal and occasionally the immediately su-prabasal keratinocytes. There is often pigmentary incontinence and melanophages in the superficial corium (Fig. 3.12).
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