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Treatment Investigation of cause and elimination if possible Prognosis Excellent Physiologic Pigmentation Etiology Normal melanocyte activity Clinical Presentation Seen in all ages Symmetric distribution over many sites, gingiva most commonly Surface architecture, texture unchanged Diagnosis History Distribution Differential Diagnosis Mucosal melanotic macule Smoking-associated melanosis Superficial malignant melanoma Treatment None Prognosis Excellent Smokers Melanosis Etiology Melanin pigmentation of oral mucosa in heavy smokers May occur in up to 1 of 5 smokers, especially females taking birth control pills or hormone replacement Melanocytes stimulated by a component in tobacco smoke Clinical Presentation Brownish discoloration of alveolar and attached labial gingiva, buccal mucosa Pigmentation is diffuse and uniformly distributed