What Caused These Multiple Hyperpigmented Macules of the Mouth? Pigmented Oral Lesions: Clues to Identifying the Potentially Malignant Consultant360 56M with an asymptomatic, darkly pigmented lesion on the attached gingiva of the maxilla, an irregularly shaped macule with varied pigmentation, including shades of black, brown, and gray. Brendan Gallagher, DDS Oral medicine: 7. red and pigmented lesions Dental Update