Pigmentation of the oral mucosa occurs when one or more pigments accumulate in the mucosa and cause discoloration. 1 Oral pigmented lesions can occur in a variety of clinical conditions, from physiologic pigmentation to malignant melanoma. 2 The color of the pigmentation depends on the depth of the pigment in the mucosa. The color can be seen in various shades from brown to blue or black. 1,3,4 In addition to melanotic macules, solitary pigmented lesions of melanocytic origin (melanoacanthoma, melanoma, oral melanocytic nevus) are rarely seen in the oral mucosa. 5 Oral melanocytic nevi are benign neoplasms composed of cells of the neural crest, often referred to as nevus cells. 6 A melanocytic nevus is a focal proliferation of nevus cells that may be congenital or acquired. These lesions are typically found on the skin but rarely on the oral mucosa. 5 Their etiology and pathogenesis are not fully understood. 7 They are examined histopathologically in 3 stages: First, a junctional nevus, which is the proliferation of nevus melanocytes throughout the submucosal-mucosal junction; second, a compound nevus, which involves migration of nevus cells into the underlying mesenchymal tissue, and third, a subepithelial or intramucosal nevus, which involves loss of the submucosal-mucosal junction so that all remaining