Disease directory
Melanotic macule
Published: September 18, 2026Updated: September 18, 2026
Important: Informational content intended for healthcare professionals. It does not replace clinical evaluation or establish a doctor-patient relationship.
Overview
- 1a. Definition and synonyms
- A melanotic macule is a benign macular hyperpigmentation of the mucosa (common on the lips and oral cavity , and also on the vulva/perineum ), histologically characterized by increased melanin in the basal layer with minimal or no melanocytic proliferation and no significant atypia. (Kaugars 1993 , Ho 1993 , De Giorgi 2020)
Clinical names/use according to location: labial melanotic macule , oral melanotic macule , vulvar melanosis (or vulvar melanotic macules ). Gupta 1997 , Kaugars 1993 , De Giorgi 2020
- A melanotic macule is a benign macular hyperpigmentation of the mucosa (common on the lips and oral cavity , and also on the vulva/perineum ), histologically characterized by increased melanin in the basal layer with minimal or no melanocytic proliferation and no significant atypia. (Kaugars 1993 , Ho 1993 , De Giorgi 2020)
- First description
- Oral melanotic macules were established as a clinicopathological entity in classic series (e.g., 1979 ). Buchner 1979
- The term and clinical delimitation of “labial melanotic macule” was proposed in the dermatological literature in 1987. Spann 1987
- Epidemiology (practical points)
- Oral/labial (large series) : mean age ~ 43 years , female predominance , and lower lip as a frequent site (≈ one third in that series); mean size ~ 6.8 mm . Kaugars 1993
- Labial (clinical pigmented lesions) : follow-up up to ~ 13 years with no growth/darkening in that cohort. Gupta 1997
- Vulvar : cohort of 129 women , mean age ~ 46 years , with long-term follow-up and no documented malignant evolution (median ~13 years). De Giorgi 2020
- In oral mucosa clinics, pigmented oral lesions (including melanotic macules) are a common reason for consultation/screening. Hassona 2016
- ICD-10 / ICD-11 Codes
- There is no single universal code specific to “melanotic macule”; in practice it is coded under categories of pigmentation disorders or 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 red flags are present: 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 adjunctive therapy. De Giorgi 2020 , Schmitt 2023 , McCollum 2025
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