Labial Melanotic Macule – Expert Diagnosis of Lip & Genital Pigmentation in London

What is a labial melanotic macule?

A labial melanotic macule is a benign pigmented lesion that most often appears on the lower lip. It is caused by increased melanin (pigment) in the basal layer of the epidermis but without abnormal melanocyte growth. Unlike melanoma, it does not spread, cause symptoms, or pose a risk to health. It is sometimes called a labial lentigo or oral melanotic macule if located inside the mouth.

The importance of recognising this lesion lies in its appearance: it may closely resemble melanoma and other pigmented oral lesions, so careful clinical assessment is key.

Causes and risk factors

The exact cause is unknown, but several factors may contribute:

• Genetic tendency: Some individuals naturally develop pigmented lesions more readily.
• UV exposure: Although not a direct cause, sun exposure may darken existing lesions.
• Hormonal factors: Lesions may appear more frequently in women, possibly linked to hormonal influences.
• Idiopathic: In most cases, no clear trigger is identified.

Symptoms and appearance

The classic features of a labial melanotic macule include:

• Single, flat spot on the lip, most often the lower lip.
• Uniform light to dark brown colour (sometimes black).
• Oval or round shape with well-defined borders.
• Stable in size (usually 2–10 mm) and non-progressive.
• Asymptomatic—no pain, itch, or bleeding.

Some patients may develop more than one macule, particularly in syndromes such as Peutz–Jeghers syndrome or Addison’s disease, but isolated lesions are far more common.

Labial Melanotic Macule Complications and concerns

The lesion itself is harmless, but the main concern is that it mimics oral melanoma, a rare but aggressive cancer. This is why professional evaluation is necessary. Any pigmented lesion in the oral cavity that changes in appearance, bleeds, or ulcerates warrants urgent review.

Labial Melanotic Macule Diagnosis

Diagnosis is usually made clinically by a dermatologist. In some cases, dermoscopy or biopsy may be performed to confirm the benign nature and to rule out malignancy. Histology typically shows increased melanin in basal keratinocytes without atypical melanocytes.

Labial Melanotic Macule Treatment

Treatment is not medically required. However, if the lesion causes cosmetic concern, options include:

• Laser therapy: Q-switched laser can reduce pigmentation with minimal scarring.
• Cryotherapy: Freezing the lesion can lighten pigmentation but may risk lip texture changes.
• Surgical excision: Rarely performed, but ensures complete removal and histological confirmation.

Patients are advised to monitor for changes and practice sun protection with SPF lip balms to prevent darkening.

Living with a labial melanotic macule

Most patients live with the lesion without issues. Regular dental or dermatology check-ups provide reassurance. Good lip care with emollients and sunscreen helps maintain comfort and appearance. Psychological reassurance is important, especially for patients anxious about the risk of melanoma.

Why choose Skinhorizon for labial melanotic macule?

• Consultant dermatologist-led assessment with dermoscopy and, if required, biopsy to rule out melanoma.
• Clear, evidence-based reassurance or treatment tailored to your goals.
• Access to advanced laser techniques for safe cosmetic improvement.
• CQC-regulated clinic in London providing rapid access to expert care.

Your first visit — what to expect

1. History: Onset, stability, and any changes in the lip lesion.
2. Examination: Dermoscopic analysis of the pigmentation pattern.
3. Investigations: Biopsy if there is diagnostic uncertainty.
4. Plan: Reassurance if benign, or discussion of cosmetic treatment options.
5. Follow-up: Monitoring for changes, especially if multiple oral pigmented lesions are present.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025