Etiology • Most idiopathic, some postinflammatory, some drug-induced • Multiple lesions suggest syndrome association, as follows:
• Peutz-Jeghers syndrome • Laugier-Hunziker phenomenon • Carney’s syndrome • LEOPARD syndrome
Clinical Presentation • Most in adulthood (fourth decade and beyond) • Most are solitary and well circumscribed • Lower lip vermilion border most common site, mostly in
young women (labial melanotic macule) • Buccal mucosa, palate, and attached gingiva also involved
• Peutz-Jeghers syndrome • Laugier-Hunziker phenomenon • Carney’s syndrome • LEOPARD syndrome
Clinical Presentation • Most in adulthood (fourth decade and beyond) • Most are solitary and well circumscribed • Lower lip vermilion border most common site, mostly in
young women (labial melanotic macule) • Buccal mucosa, palate, and attached gingiva also involved
(mucosal melanotic macule) • Usually brown, uniformly pigmented, round to ovoid shape
with slightly irregular border • Usually < 5 mm in diameter
Microscopic Findings • Normal melanocyte density and morphology • Increased melanin in basal cells and subjacent macrophages
(mucosal melanotic macule) • Increased melanin in basal cells with elongated rete pegs
(ephelides)
Diagnosis • Biopsy
Differential Diagnosis • Melanoacanthoma • Mucosal melanotic macule • Congenital syndromes (Carney’s, Peutz-Jeghers, LEOPARD,
Laugier-Hunziker)
Treatment • Observation • Biopsy for esthetics • If increase in size or development of atypical signs occurs,
macule should be removed to rule out malignant melanoma, particularly if on palate or alveolar mucosa.
Prognosis • Excellent