What Is Labial Melanosis (Spots on the Lips)?

Small brown to blackish-brown spots can form on the lips. This is called labial melanosis (labial melanotic macule).

Labial melanosis is often a benign pigmentation, but the lips are a site where it needs to be distinguished from moles, venous lakes, vascular lesions, Peutz-Jeghers syndrome, and rarely malignant melanoma.

Features of Labial Melanosis

Labial melanosis is a flat brown to blackish-brown spot that forms on the lower or upper lip. There may be just one, or there may be several.

Ultraviolet light, dryness, friction, chronic cheilitis, atopic dermatitis, smoking, and the like can be involved, but sometimes the clear cause is unknown.

Diagnosis

At our clinic, we first use dermoscopy to check the distribution of pigment and the presence or absence of a vascular component.

Even if it looks like labial melanosis, it may actually be a different lesion, such as a mole, venous lake, vascular lesion, or post-traumatic pigmentation. Because the suitable treatment differs depending on the diagnosis, we examine it before laser irradiation.

If it has suddenly grown larger over a short period, has darkened, has an irregular shape, bleeds, has a lump, or if similar spots have appeared on the hands or feet, we may switch from cosmetic laser treatment to care under insurance.

Treatment Methods

For spot-like marks, the lips are often difficult to improve with topical drugs, so if they bother you, we perform laser treatment.

At our clinic, using the Discovery PICO Plus, we can choose from a Q-switched ruby laser, a Q-switched YAG laser, and a pico YAG laser, but for typical labial melanosis we make the Q-switched ruby laser, which has high melanin selectivity, the first choice.

Pigmented spots on the lips often respond well to the laser, and they can fade considerably with a single irradiation. However, depending on the depth and extent of the color and on your constitution, several sessions of irradiation may be necessary.

Note that for widespread lip spots (diffuse labial pigmentation), taking into account the effects of dryness, inflammation, friction, and the like, we may first start with moisturizing or topical treatment. If laser treatment is performed, we may propose ruby fractional, which tends to have less downtime than spot irradiation with the ruby laser.

Recovery After Treatment

Immediately after spot irradiation with the laser, the irradiated area may turn whitish or swell a little. After that, it becomes scab-like within a few days and naturally peels off in about one to two weeks.

Rubbing it forcibly can lead to pigmentation or slower healing, so please do not touch the scab until it comes off naturally.

For a while after treatment, avoid dryness and friction of the lips and moisturize well. Because this is a site affected by ultraviolet light, a lip balm with UV-blocking properties is also useful when going out.

Side Effects and Risks

With laser treatment, redness, swelling, pain, scabbing, bruising, post-inflammatory hyperpigmentation, loss of pigment, blisters, erosion, infection, scarring, and the like may occur.

The lips are a relatively easy area to heal, but if you rub them hard, peel off the scab, let them stay dry, or have repeated cheilitis, post-treatment pigmentation can be prolonged.

Frequently Asked Questions

Q: Can labial melanosis be treated with insurance?

A: Treatment to lighten spots for cosmetic purposes is self-pay. If malignancy is suspected or if examination for diagnostic purposes is needed, we consider handling it under insurance.

Q: How many sessions does it take to remove?

A: It can fade considerably in a single session, but depending on the depth and size of the pigment, several sessions are needed. When re-irradiating, we decide after the post-treatment pigmentation has settled.

Q: Is tape protection needed after the laser?

A: The lips usually do not need tape protection like that used for facial spot treatment. Moisturize sufficiently and avoid forcibly peeling off the scab.

Q: Can moles on the lips be removed with the same laser?

A: For a flat mole it may work, but it can recur. For raised ones, those with deep pigment, or those with an irregular shape, we propose a suitable method after examination.