Pigmented Oral Lesions: Clues to Identifying the Potentially Malignant Consultant360 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. Pigmented Lesions of the Oral Cavity Oral and Maxillofacial Surgery Clinics In the process of removing a Labial Melanotic Macule. A Labial Melanotic Macule is a well defined, oval, brown to black, flat patch on the central third of the lower lip, as seen Pigmented (Purple or Brown) Lesions in the Mouth Pigmented (Purple or Brown) Lesions in the Mouth Kazemi Oral Surgery Facialart.com