Oral mucosal hyperpigmentation refers to the intraoral deep-purple, brown or black patch that most commonly affects the gingival surface. 1 Different pathological conditions are associated with oral mucosal hyperpigmentation: genodermatoses including Peutze Jeghers syndrome, endocrinopathies such as Addison's disease and acromegaly, post-inflammatory hyperpigmentation, drug-induced pigmentation (e.g., minocycline, zidovudine, chlorpromazine), heavy metal depositions (e.g., lead, bismuth, mercury) and Amalgam tattoo, to name a few. 2 Physiologic (primary) hyperpigmentation of the oral mucosa is a benign condition that results from increased melanin production. It