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All cases of melanocytic lesions of the oral mucosa, benign and malignant, accessioned by the AFIP during a 28‐year period have been reviewed. There were 135 acceptable cases, 93 of which were benign and 42 malignant. A majority of the benign lesions occurred on the vermilion of the lips, whereas the sites of highest incidence of malignant melanoma were the palate and gingiva. Most of the benign lesions appeared clinically innocuous, and, significantly, a fourth of the malignant melanomas were described as merely a “Pigmented spot.” The patients with benign melanocytic lesions had a mean age of 26.8 years, while the age of those with malignant melanoma averaged 49.5 years. With due consideration of the population served by the AFIP, there was no statistically significant racial difference in the incidence of either benign or malignant lesions. Likewise, there was no sex difference in the occurrence of benign lesions. There was, however, an apparent predilection for the male in cases of malignant melanoma in the series. The authors conclude that, unless oral pigmentation is unequivocally racial in origin or the lesion can be clinically demonstrated to be caused by a material or pigment other than melanin, excisional biopsy is indicated.

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