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Multiple causes of hyperpigmented lesions of the oral mucosa are known, with oral and labial melanotic macules as the most common melanotic lesions.1,2 Trauma, radiation, and medications may result in an increased production of melanin seen in melanotic macules, but the pathophysiological mechanism of this disorder is still unknown.1,2 Histologically, melanotic macula of the oral and labial mucosa is characterized by increased melanin in the basal cell layer and lamina propria

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Under this structure, differences in approval, timing, cost, and fulfillment reflect how responsibilities are divided across the system rather than individual behavior