Oral Melanotic Macule: Symptoms and Treatment Skinsight Spotty lips. These are labial melanotic macules, kinda like freckles on the lips. They are mostly due to age and sun exposure, but sometimes they run in families and are associated with Differential Diagnosis of Pigmented Lesions in the Oral Mucosa: A Clinical Based Overview and Narrative Review 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.