What Caused These Multiple Hyperpigmented Macules of the Mouth? COM March 2009 Diagnosis UW School of Dentistry dermoscopy: A pigmented labial lesion Pigmented Lesions of the Oral Mucosa Pocket Dentistry The labial melanotic macule: a review of 79 cases This patient has multiple labial melanotic macules. These are essentially freckles of the lips. These most commonly involve the lower lip. This patient had involvement of both the upper and lower lips.