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. Oral melanoma and other pigmentations: when to biopsy? Lambertini 2018 Journal of the European Academy of Dermatology and Venereology Wiley Online Library Pathology Outlines Melanotic macule Melanotic Macules, Naevi, and Melanoma Springer Nature Link