What Is a Melanotic Macule?

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  • Written By: Mary McMahon
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 12 October 2019
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A melanotic macule is a small dark spot that is usually benign, but may be a cause for concern if it changes in color, shape, or texture. These spots usually appear on the lips or genitals and can have a number of causes. A dermatologist can evaluate a melanotic macule to determine if it poses any health risks to the patient. Patients who do not like the appearance of the spot can discuss options for minimizing it.

Some people are born with melanotic macules, or they appear early in childhood. This is especially common in darker-skinned people. Others may develop them in response to environmental stress like smoking, persistent sun exposure, or medications known to cause spotting and darkening of the skin. Sometimes, the spot is an indicator of an underlying medical condition like Addison's disease.

The melanotic macule should be small, flat, and darker than the surrounding tissue. If it appears suddenly, changes size, or starts to roughen, it may be malignant. A doctor can examine the spot and rule out possible causes to determine if a biopsy is necessary. If the patient is taking a medication known to cause hyperpigmentation, for example, the macule is probably not malignant, and is simply a response to the drugs.


In the event a doctor has concerns about a melanotic macule, she can take a small scraping or other sample and send it to a pathologist. The pathologist will examine the sample under a microscope to determine what kinds of cells are present. He will look for signs of abnormal cells and can determine if the spot is cancerous or precancerous. The doctor may recommend removal to be on the safe side, as some lesions can turn malignant over time.

Removal of a melanotic macule can create a small depression or scar in the tissue. If the lesion is especially large or irregular in shape, this may be noticeable. In other patients, the tissue will heal well and may leave little to no sign of the lesion behind. After removal, patients with a history of such lesions may want to discuss them with a doctor, as this could have an impact on the way the doctor evaluates new lesions.

Many melanotic macules are small and light enough to be invisible under makeup, and they may not attract very much attention. If the patient is bothered by the spot, she can discuss removal options with the doctor. The doctor may advise against a purely cosmetic removal procedure because of concerns about scarring.


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