Labial melanotic macule COM Jan. 2008 Diagnosis UW School of Dentistry What Caused These Multiple Hyperpigmented Macules of the Mouth? COM March 2009 Diagnosis UW School of Dentistry 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. The labial melanotic macule: a review of 79 cases