Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review Is focal melanotic lesion potentially malignant? A case report ScienceDirect Pigmented Lesions of the Oral Mucosa Springer Nature Link 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.