Dark pigmentation in the oral cavity Clinical Advisor Oral Melanotic Macule: Symptoms and Treatment Skinsight What Caused These Multiple Hyperpigmented Macules of the Mouth? 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. Summit Enlighten Laser to treat labial melanotic macules on the lip before and after. Facebook