Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review An oral melanotic macule is a harmless dark spot found on the lip, most often the lower lip, or inside the mouth, either on the gums, inside the cheek, or on the roof of the mouth. An oral melanotic Multifocal pigmentation of the oral mucosa The Journal of the American Dental Association 56M with an asymptomatic, darkly pigmented lesion on the attached gingiva of the maxilla, an irregularly shaped macule with varied pigmentation, including shades of black, brown, and gray. Brendan Gallagher, DDS Pigmented Lesions of the Oral Mucosa Pocket Dentistry