Pigmented Lesions of the Oral Cavity Oral and Maxillofacial Surgery Clinics What Caused These Multiple Hyperpigmented Macules of the Mouth? 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.