Many individuals observe various spots and discolorations on their tongues. While “freckle” is commonly associated with skin, similar spots can appear in the mouth. The tongue can develop benign pigmentations, alongside other common changes. Understanding these variations helps distinguish between harmless occurrences and those that might warrant professional attention.
Oral Pigmented Spots
The tongue can develop flat, benign pigmented spots known as oral melanotic macules. These spots are caused by an increased concentration of melanin-producing cells, called melanocytes, in the affected area. Oral melanotic macules often appear as flat patches ranging from brown to black or even blue. They can occur anywhere on the tongue, and are also common on the lips, gums, and palate.
Unlike skin freckles, which typically darken with sun exposure, oral melanotic macules do not change in response to sunlight. These lesions are generally harmless, representing a localized excess of melanin deposition within the tissue. They are among the most common pigmented lesions found in the oral cavity.
Other Common Tongue Discolorations
Beyond melanotic macules, several other conditions can cause distinct spots or changes in tongue coloration. Oral nevi, often referred to as moles in the mouth, are less common than their skin counterparts but can appear as small, well-circumscribed brown, bluish-gray, or almost black lesions that may be slightly raised. These are benign growths of melanocytes.
Traumatic pigmentation can arise from localized injury, such as accidentally biting the tongue or irritation from dental work. This type of discoloration is a healing response and often results in a dark spot where the tissue was damaged. Another common, harmless condition is geographic tongue, characterized by smooth, red, irregularly shaped patches that often have white borders. These patches can change size, shape, and location over days or weeks, giving the tongue a map-like appearance.
Black hairy tongue is a condition where the small, thread-like bumps on the tongue, called filiform papillae, grow longer than usual and trap food particles, bacteria, or yeast. This can cause the tongue to appear dark and furry, often brown or black. Poor oral hygiene, certain medications, and tobacco use can contribute to its development. Some medications can also cause tongue discoloration as a side effect, varying in color.
When to Seek Medical Advice
While many tongue spots are benign, some changes warrant evaluation by a healthcare professional. It is advisable to seek medical advice for any new spot that appears suddenly, or if an existing spot changes in size, shape, color, or texture. Spots that are raised, lumpy, or have irregular borders should also be examined.
Any spot on the tongue that bleeds, is painful, or does not heal within a few weeks should prompt a visit to a doctor or dentist. Associated symptoms, such as difficulty swallowing or persistent soreness, are also concerning signs. Although rare, oral melanoma is a serious condition that can present as a brown or black spot, and early detection is important for effective management.