Pigmented Lesions of the Oral Mucosa Springer Nature Link Labial Macules: Dark Spots on the Lip Dermatology Advisor Melanotic macule MEDizzy 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. What Caused These Multiple Hyperpigmented Macules of the Mouth?