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Melanotic macule

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Melanotic macule

Created: 13/12/2025 Last updated: 13/12/2025 Important: This content is for informational purposes only and is intended for healthcare professionals. It does not replace clinical assessment or medical judgment, does not establish a doctor-patient relationship, and does not constitute a standard of care. Medicine is rapidly evolving: always verify sources and use this information only as additional input for decision-making.

General

  • 1a. Definition and synonyms
    • La melanotic macule (melanotic macule) is a benign macular hyperpigmentation of mucosa (frequent in lip y oral cavity, and also in vulva/perineum), histologically characterized by increased melanin in the basal layerwith minimal or no melanocytic proliferation and without significant atypia. Kaugars 1993, I have 1993, De Giorgi 2020
      Names/clinical use according to location: labial melanotic macule, oral melanotic macule, vulvar melanosis (o vulvar melanotic macules). Gupta 1997, Kaugars 1993, De Giorgi 2020
  • First description
    • La oral melanotic macule It was consolidated as a clinicopathological entity in classic series (e.g., 1979). Buchner 1979
    • The term and clinical delimitation of “labial melanotic macule” It was proposed in the dermatological literature in 1987. Spann 1987
  •  Epidemiology (practical points)
    • Oral/labial (large series): middle age ~43 years in the Making, female predominance, and lower lip as a frequent site (≈ one third in that series); average size ~6.8 mm. Kaugars 1993
    • Labial (pigmented lesion clinic): tracking up to ~13 years in the Making without growth/darkening in that cohort. Gupta 1997
    • Vulvarcohort of 129 women, middle age ~46 years in the Making, with prolonged follow-up without documented malignant evolution (median ~13 years). De Giorgi 2020
    • In oral mucosa consultations, the pigmented oral lesions (including melanotic macules) are a common reason for consultation/screening. Hassona 2016
  • ICD-10 / ICD-11 Codes
    • There is no unique universal code specific for “melanotic macule”; in practice it is coded under categories of pigmentation disorders o mucosal lesion depending on the site (this varies by country/insurer; check local manual).
  • Diagnostic checklist (quick)
    • History: onset, changes, symptoms, trauma/irritation, drugs, personal/family history of melanoma.
    • Complete examination of mucous membranes (oral and genital if applicable) and skin.
    • Dermatoscopy ± baseline photography/annual follow-up if observed (especially vulva). De Giorgi 2020
    • If there are red flags: biopsy (excisional if small and feasible; incisional/punch if large or complex site). Gupta 1997, De Giorgi 2020
    • If histological doubt persists: IHC (MART1/tyrosinase, Ki-67) ± PRAME As support. De Giorgi 2020, Schmitt 2023, McCollum 2025
  • Frequently idiopathic; it is interpreted as focal reactive/benign melanosis of mucosa. I have 1993, Kaugars 1993
  • En vulva, there may be a relationship with Hormonal status/hormone therapy (association suggested by longitudinal cohort). De Giorgi 2020
  • Important syndromic approach: multiple mucosal macules may be part of Laugier–Hunziker syndrome(benign) or other mucosal pigmentation scenarios where the differential diagnosis changes. Veraldi 1991
  • Elementary injury: taint coffee to dark coffee (sometimes patchy), usually asymptomatic. Gupta 1997, De Giorgi 2020
  • Typical areas
  • prototypical picture
    • Single, well-defined, homogeneous brown macule, stable over time; it is usually consulted to rule out mucosal melanoma. Gupta 1997, De Giorgi 2020
  • Clinical findings/dermatoscopy (keys)
    • In mucosa, dermatoscopy helps to describe benign patterns of melanosis. Mannone 2004
    • En labial melanotic maculeUseful dermatoscopic patterns have been described, such as “landscape painting"in clinical series." Kim Xnumx
    • Common differential diagnosis in lip: venous lakeDermatoscopy may show indicative vascular/lacunar findings. Read 2018
  • Clinical evolution
    • Generally benign and stableIn one lip cohort, there was no growth/darkening during prolonged follow-up. Gupta 1997
    • In the vulva, up to 30% may change size/color and then stabilize, without malignant transformation in prolonged follow-up. De Giorgi 2020
  • Atypical forms (practical guidance)
    • Multifocality (especially vulvar) and less defined edges They can occur and increase diagnostic anxiety, without implying malignancy in themselves. De Giorgi 2020
    • Multiple mucosal macules with melanonychia suggest evaluating Laugier–Hunziker (benign) and systemic differentials. Veraldi 1991
  • Histological pattern
    • Melanosis/benign pigmented macule: basal hyperpigmentation ± melanophages superficial, without new architecture. Kaugars 1993, De Giorgi 2020
  • Characteristic findings (by site)
    • Oral: melanin evident in basal layer y own page in most cases of large series. Kaugars 1993
    • LabialClinicopathological/ultrastructural studies support the benign nature with basal pigmentary changes. I have 1993, Gupta 1997
    • Vulvar: may be accompanied by acanthosis and basal hyperpigmentation; IHC may highlight mild melanocytic increase without significant atypia. De Giorgi 2020
  • Special stains / immunohistochemistry (when needed)
    • IHC melanocytic (e.g., MART1/tyrosinase) can help map melanocytic distribution when there is diagnostic doubt. De Giorgi 2020
    • Profiles have been described in genital melanotic macules with HMB-45 negative in case/series evaluation. Lenane 2000
    • PRAMEIn pigmented oral lesions, PRAME was negative in melanotic macules and strong/diffuse positive in most melanomas evaluated; useful as support, not a substitute for morphology. Schmitt 2023
    • In the vulva/perineum, PRAME was 0 in multiple benign lesions (including melanosis/macules/lentigines) and typically high in malignant lesions of the melanoma spectrum in that series. McCollum 2025
  • molecular tests
    • They are not routine for the diagnosis of melanotic macules; they are reserved for scenarios of oncological doubt according to local protocol.
Melanotic macule: Characterized by hyperpigmentation (melanin) of the keratinocytes of the basal layer (in the case of mucous membranes it is usually accentuated at the bases of the clubs)

 

Melanotic macule: hyperpigmentation of the basal layer (blue arrows) without evidence of melanocytic proliferation and/or presence of a nevus component

 

 

 

  • Mucosal melanoma/melanoma in situ (melanocytic atypia, pagetoid pattern, etc.). Schmitt 2023, McCollum 2025
  • Genital nevus / “genital lentiginosis” (Special site melanocytic lesions can mimic atypia). Barnhill 1990
  • Melanosis vs atypical melanocytic lesionClinical-dermatoscopic and histological correlation is critical. De Giorgi 2020
  • Usually no laboratory required if it is a typical and stable single injury. Gupta 1997
  • If there multiple mucosal maculesDiffuse pigmentation or systemic data: guide studies according to suspicion (e.g., causes of oral pigmentation) and review drugs/exposure; the syndromic approach is discussed in reviews of pigmented oral lesions. Gondak 2012, Veraldi 1991
  • Biopsy
    • Type of biopsy
      • Lip (small lesion): prefer excisional with narrow margins if it is feasible and aesthetically pleasing (allowing for complete architecture) when there is doubt. Gupta 1997
      • Oral (mucosa): incisional If size/location warrants it; include epithelium and lamina propria. Kaugars 1993
      • Vulva/perineum: punch or incisional directed at the most suspicious area; correlate with dermatoscopy/serial photography. De Giorgi 2020
    • Technical considerations
    • Biopsy if there is marked asymmetry, polychromy, blue/white, nodularity, ulceration/bleeding, rapid growth or clinical-dermatoscopic discordance. De Giorgi 2020, Uribe 2017
    • Document with dermatoscopy and photography for monitoring when observation is decided. De Giorgi 2020
    • Contraindications
      • Relative contraindications: uncorrected coagulation disorders, active local infections; individualize.
    • Fixation/transfer
      • 10% Formalin for routine histology
  • First line (most important)
    • Reinsurance and high with instructions to return if there is growth or darkening (This did not occur in a series with prolonged follow-up). Gupta 1997
    • En vulvaClinical/dermoscopic monitoring if changes occur, knowing that they can stabilize without becoming malignant. De Giorgi 2020
  • Second/third line (selected cosmetic or symptomatic)
    • Q-switched ruby ​​laser: small series with good response and no pigmentary recurrence reported in follow-up up to 24 months. Gupta 1999
    • Cryosurgery: described as a simple option for oral melanotic macule (note: confirm benignity before treating). Yeh 2000
  • General care / safety
    • Avoid destructive treatments "blindly" if the diagnosis is not firm; consider dermatoscopy, MCR or biopsy first depending on the risk. Uribe 2017, Gupta 1997
    • If laser/cryosurgery is used: inform about the risk of post-inflammatory hypo/hyperpigmentation and the need for follow-up.
  • Contraindications (relative)
    • They depend on the procedure (e.g., cryosurgery/laser) and the clinical context; individualize.
  • Rapid growth, new beginning in mucosa with accelerated changes, ulceration, Bleeding, pain. De Giorgi 2020
  • Polychromy (especially blue/white), nodule o high component, marked asymmetry or clinical-dermatoscopic discordance. De Giorgi 2020, Uribe 2017
  • Pigmented genital/oral lesion where histology is difficult: consider PRAME as support alongside morphology. Schmitt 2023, McCollum 2025
  • Most are benign and stable (lip and vulva with long follow-up without malignant transformation). Gupta 1997, De Giorgi 2020
  • There may be in the vulva initial changes and then stabilization without implying malice. De Giorgi 2020
  • MCR/dermatoscopy, when used correctly, can reduce unnecessary biopsies and improve the selection of lesions to be sampled. Uribe 2017, Mannone 2004

  • Spann CR, et al. The labial melanotic macule. Arch Dermatol. 1987;123(8):1029–1031. DOI: (not indexed in PubMed). PMID: 3631980. Spann 1987
    Summary: Classic article that proposes/defines the clinical entity “melanotic labial macule” as a benign pigmented lesion of the lip, helping to differentiate it from melanoma and other causes.

  • Gupta G, Williams RE, Mackie RM. The labial melanotic macule: a review of 79 cases. Br J Dermatol.1997;136(5):772–775. DOI: (not indexed in PubMed). PMID: 9205516. Gupta 1997
    Summary: Clinical cohort with long-term follow-up (up to ~13 years) that supports benign behavior and suggests primary management with reassurance and surveillance if it changes.

  • Ho KK, Dervan P, O'Loughlin S, Powell FC. Labial melanotic macule: a clinical, histopathologic, and ultrastructural study. J Am Acad Dermatol. 1993;28(1):33–39. DOI: 10.1016/0190-9622(93)70005-E. PMID: 8425968. I have 1993
    Summary: Comprehensive review/study (clinical + histology + ultrastructure) that reinforces the benign nature of the labial melanotic macule and its microscopic features.

  • Mannone F, et al. Dermoscopic features of mucosal melanosis. Dermatol Surg. 2004;30(8):1118–1123. DOI:10.1111/j.1524-4725.2004.30337.x. PMID: 15274702. Mannone 2004
    Summary: Describe dermatoscopic patterns of mucosal melanosis/melanotic macules, useful for determining benignity and selecting lesions for biopsy.

  • Kim GW, et al. Dermoscopic “Landscape Painting Patterns” as a Clue for Labial Melanotic Macules: An Analysis of 80 Cases. Ann Dermatol. 2018;30(3):331–334. DOI: 10.5021/ad.2018.30.3.331. PMID: 29853748. Kim Xnumx
    Summary: Series that proposes characteristic dermatoscopic patterns (“landscape painting”) to support the diagnosis of labial melanotic macule.

  • Uribe P, et al. In Vivo Reflectance Confocal Microscopy for the Diagnosis of Melanoma and Melanotic Macules of the Lip. JAMA Dermatol. 2017;153(9):882–891. DOI: 10.1001/jamadermatol.2017.0504. PMID: 28467525. Uribe 2017
    Summary: Observational study evaluating MCR in vivo to differentiate lip melanoma vs melanotic macules, supporting its use in non-invasive triage.

  • Lee JS, et al. Dermoscopy for venous lake on the lips: A comparative study with labial melanotic macule. PLoS One. 2018, 13 (11): e0206768. DOI: 10.1371 / journal.pone.0206768. PMID: 30379954. Read 2018
    Summary: Dermatoscopic comparison between venous lake and labial melanotic macule; useful to avoid unnecessary biopsies when the pattern is typical.

  • Buchner A, Hansen LS. Melanotic macule of the oral mucosa. A clinicopathologic study of 105 cases. Oral Surg Oral Med Oral Pathol. 1979;48(3):244–249. DOI: 10.1016/0030-4220(79)90011-2. PMID: 289929. Buchner 1979
    Summary: Foundational series that characterizes the clinical and histological features of oral melanotic macules and consolidates clinicopathological criteria.

  • Kaugars GE, et al. Oral melanotic macules. A review of 353 cases. Oral Surg Oral Med Oral Pathol. 1993;76(1):59–61. DOI: 10.1016/0030-4220(93)90295-F. PMID: 8351123. Kaugars 1993
    Summary: Large series with epidemiological data (female predominance, average age, size) and anatomical distribution; reports basal/lamina propria melanin as a frequent finding.

  • Gondak RO, et al. Oral pigmented lesions: Clinicopathologic features and review of the literature. Med Oral Pathol Oral Cir Bucal. 2012;17(6):e919–e924. DOI: 10.4317/medoral.17679. PMID: 22549672. Gondak 2012
    Summary: Practical review of pigmented oral lesions (including melanotic macule) with a focus on differential diagnosis and clinicopathological correlation.

  • Hassona Y, et al. Prevalence and clinical features of pigmented oral lesions. Int J Dermatol. 2016;55(9):1005–1013. DOI: 10.1111/ijd.13133. PMID: 26711197. Hassona 2016
    Summary: Clinical epidemiological study on pigmented oral lesions; provides context of frequency and presentation in practice.

  • Yeh CJ. Simple cryosurgical treatment of the oral melanotic macule. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(1):12–13. DOI: 10.1067/moe.2000.104851. PMID: 10884628. Yeh 2000
    Summary: Brief communication describing cryosurgery as a simple therapeutic alternative for oral melanotic macule (in appropriate context).

  • Gupta G, MacKay IR, MacKie RM. Q-switched ruby ​​laser in the treatment of labial melanotic macules. Lasers Surg Med. 1999;25(3):219–222. DOI: 10.1002/(sici)1096-9101(1999)25:3<219::aid-lsm5>3.0.co;2-k. PMID: 10495298. Gupta 1999
    Summary: Small series of treatment with Q-switched ruby ​​laser with good cosmetic response and no pigment recurrence reported in follow-up.

  • De Giorgi V, et al. Clinical and Dermoscopic Features of Vulvar Melanosis Over the Last 20 Years. JAMA Dermatol. 2020;156(11):1185–1191. DOI: 10.1001/jamadermatol.2020.2528. PMID: 32785609. PMCID:PMC7658736. De Giorgi 2020
    Summary: Longitudinal cohort with serial photodermatoscopy demonstrating benign behavior (without malignant transformation) despite initial changes in a subgroup; suggests association with hormonal status.

  • Ferrari A, et al. Dermoscopic and confocal microscopy patterns of vulvar mucosal melanotic macules. J Am Acad Dermatol. 2014;70(4):e81–e82. DOI: 10.1016/j.jaad.2013.10.038. PMID: 24629367. Ferrari 2014
    Summary: Report correlating dermatoscopy and MCR in vulvar melanotic macules, supporting non-invasive evaluation and biopsy selection.

  • Barnhill RL, et al. Genital lentiginosis: a clinical and histopathological study. J Am Acad Dermatol. 1990;22(3):453–460. DOI: 10.1016/0190-9622(90)70064-O. PMID: 2312832. Barnhill 1990
    Summary: Clinicopathological study of genital lentiginosis, relevant for the histological and clinical differential of benign genital pigmentations vs atypical entities.

  • Lenane P, et al. Genital melanotic macules: clinical, histologic, immunohistochemical, and ultrastructural features. J Am Acad Dermatol. 2000;42(4):640–644. DOI: (not indexed in PubMed). PMID: 10727311. Lenane 2000
    Summary: Characterizes genital melanotic macules with IHC/ultrastructure support; useful to distinguish from true melanocytic proliferations.

  • Veraldi S, et al. Laugier-Hunziker syndrome: a clinical, histopathologic, and ultrastructural study of four cases and review of the literature. J Am Acad Dermatol. 1991;25(4):632–636. DOI: 10.1016/0190-9622(91)70244-V. PMID:1791220. Veraldi 1991
    Summary: Review with cases describing a benign syndrome with mucosal pigmentation and melanonychia; key for differentials when there are multiple lesions.

  • Schmitt TA, et al. PRAME immunohistochemistry is useful in differentiating oral melanomas from nevi and melanotic macules. J Cutan Pathol. 2023;50(3):275–278. DOI: 10.1111/cup.14361. PMID: 36398487. Schmitt 2023
    Summary: Retrospective oral series with PRAME: negative in melanotic nevi/macules and strongly/diffusely positive in most melanomas; useful as a complementary tool.

  • McCollum KJ, Selim MA, Schneider M. PRAME Immunohistochemistry for Differentiating Pigmented Lesions of the Vulva and Perineum. J Cutan Pathol. 2025;52(10):644–654. DOI: 10.1111/cup.14850. PMID: 40717218. McCollum 2025
    Summary: Genital series with PRAME/MART1: PRAME 0 in benign lesions (mostly melanosis/macules/lentigines and nevi) and high in melanomas; supports its use in the diagnostic algorithm.

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