Tongue Discoloration New England Journal of Medicine Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review A 9 year old boy presented for evaluation of dark spots on the tongue. The family first noted these spots 5 months prior and reported that they remained stable. Can you make a diagnosis? Pigmented fungiform papillae, or papillary tip melanosis Registered Dental Hygienists Cutaneous adverse drug reaction image