SUMMARY


Oral pigmentations may be focal, diffuse, or multifocal. They may be blue, purple, brown, gray, or black. They may be flat or tumefactive. Importantly, some are harbingers of internal disease; some are localized harmless accumulations of melanin,
hemosiderin, or exogenous metal; and some can be highly lethal. The differential diagnosis can be lengthy, particularly when the pigmentation is macular and diffuse or multifocal. Although biopsy is a helpful aid to diagnosis for localized lesions, the more diffuse lesions will require a thorough history and laboratory studies in order to arrive at a definitive diagnosis.