About all

Dark spots in mouth: Causes and What Needs to Be Treated

Causes and What Needs to Be Treated

Finding a black spot or dot on the inside of your cheek can be alarming, but it’s not necessarily a sign of something serious.

A variety of harmless conditions can cause discoloration in your mouth, such as moles, hyperpigmentation, and leakage from your dental fillings.

In extremely rare cases, a black spot may be a sign of a type of cancer called oral melanoma. Oral melanoma accounts for about 1.6 percent of cancers of the head or neck, and less than 1 percent of all melanomas, according to The Oral Cancer Foundation.

Keep reading to find out what may be causing a black spot on the inside your cheek and when you should see your doctor.

The following conditions may cause a black dot, a small, circular mark, to form on the inside of your cheek.

Oral nevi

Oral nevi are small brown, bluish gray, or almost black dots that can appear inside your mouth. Nevi is a medical term for moles (nevus is singular).

Oral nevi are usually slightly raised. They’re more common on the roof of the mouth or inner lip, but they can also form on the cheeks. They usually don’t cause any symptoms.

No treatment is usually necessary for an oral nevus, and there are no reports of an oral nevus becoming cancerous. However, your doctor or dentist may still recommend getting a biopsy to make sure it’s indeed a nevus and not melanoma.

Blood blister

Blood blisters are sacs of fluid that fill with blood. They can range in color from purple to dark red. They commonly form when the skin in your mouth gets pinched.

Blood blisters are often big enough that you can feel them with your tongue. They most often form on the soft parts of your mouth, like your cheek or inner lips. They’re typically painful when touched, or if you eat spicy food.

The majority of blood blisters don’t last long and don’t need treatment if you leave them alone. But if the blood blister lasts for more than 2 weeks or becomes a reoccurring problem, it’s a good idea to visit your doctor.

Melanotic macules

Oral melanotic macules are areas of hyperpigmentation that average about a quarter of an inch in diameter. They can be as small as 0.04 of an inch. These spots are typically flat and have a well-defined border.

Oral melanotic macules are noncancerous, but your doctor may recommend a biopsy to rule out melanoma.

The following are potential causes of dark spots on the inside of your cheek. Spots can vary in size but they are larger than a dot.

Leakage from a dental filling

Amalgam is a material made of mercury, tin, zinc, silver, and copper. It’s been used for more than 150 years for dental fillings.

Amalgam tattoos are leakages from these dental fillings. They’re relatively common and usually appear dark blue, gray, or black. They’re most often located next to a filling.

Amalgam tattoos don’t cause any symptoms and don’t need treatment. They’re permanent unless removed with laser surgery.

Smoker’s melanosis

Smoking can leave blotchy stains called smoker’s melanosis inside your cheeks and gums. About 22 percent of people who smoke have this staining.

These stains don’t cause symptoms and don’t need treatment. However, your doctor will likely recommend a biopsy to rule out other conditions. The stains can be removed with laser treatment or electrosurgery.

Oral cancer

Melanoma is a type of skin cancer that affects pigmented cells called melanocytes.

Melanoma is most common on parts of your skin frequently exposed to sunlight, but it can also form in your mouth and nose. In extremely rare cases, a dark spot inside your cheek may be a sign of oral melanoma.

In its early stages, oral melanoma often has minimal symptoms. It usually manifests as a dark brown to blue-black spot. It can also be unpigmented or white. In its late stages, the spot may be accompanied by pain, ulcers, and bleeding.

The average age of diagnosis of oral melanoma is 56. Oral cancer is twice as common in men as women.

Treatment for oral melanoma may include:

  • surgery
  • immunotherapy
  • radiation
  • drug therapy

Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is a condition that causes noncancerous growths called polyps in the intestines and stomach.

Children who develop this condition also commonly develop dark spots on their lips, inside their mouth, near their eyes and nose, and around their anus. The spots usually fade with age.

People with Peutz-Jeghers syndrome also often develop complications such as pain, bleeding, or bowel obstruction.

There’s no current cure for Peutz-Jeghers syndrome, but surgery can remove the polyps in the digestive tract.

Addison’s disease

Addison’s disease, or adrenal insufficiency, is a deficiency of the hormones produced by your adrenal glands. One of the symptoms of Addison’s disease is hyperpigmented blotches of skin inside your mouth.

Other symptoms include:

  • extreme fatigue
  • weight loss
  • salt cravings
  • low blood sugar
  • hyperpigmentation

You can take medication to replace the hormones your adrenal glands can’t produce by themselves.

Even though the chances of developing oral melanoma is very low, it’s good practice to see your doctor whenever you notice an abnormally colored spot or dot in your mouth.

It’s especially important to get the spot checked if you’re older than 55 years. Older adults have a higher risk for developing oral cancer.

Your doctor may use the following tests to help confirm a diagnosis of the dark spot inside your cheek:

  • Physical inspection. Your doctor may be able to identify the spot during a physical examination simply based on its appearance.
  • Biopsy. During a biopsy, your doctor will cut away a small piece of the spot and send it to a lab for analysis.
  • Blood test. Your doctor may administer a blood test measuring your potassium, cortisol, and ACTH hormone levels if they suspect Addison’s disease.

Finding a dark spot or dot in your mouth is unlikely to be a sign of cancer. However, it’s still a good idea to show it to your doctor or dentist. If it does turn out to be cancerous, getting an early diagnosis and treatment can improve your outlook.

Pictures, causes, treatment, and when to seek help

Black spots inside the cheek can have several causes, such as blisters or hyperpigmentation. In rare cases, they may indicate something more serious, such as mouth cancer.

Many harmless conditions can cause a black spot to develop inside the cheek. Often, there will be no other symptoms, and it will improve without treatment.

Rarely, however, a black spot inside the cheek may be a symptom of oral melanoma. This is a rare type of cancer.

The American Cancer Society estimate that just over 54,000 people will develop mouth or throat cancer in 2021. Melanoma usually accounts for 0.5% of all oral cancers.

This article will examine some potential causes of a black spot inside the cheek. It will also look at some treatment options and when a person should contact their doctor.

Blisters are raised bubbles on the skin with fluid inside. They can occur anywhere on the body, including in the mouth.

Blood blisters contain blood and appear dark red or purple. They may develop in the mouth due to accidentally biting the cheek or as a result of an allergic reaction.

Learn more about blood blisters in the mouth here.


Blood blisters are not typically harmful, and they will often heal without treatment.

Sometimes, however, they may cause pain or discomfort. In these cases, a person can use over-the-counter (OTC) pain relief medication.

Amalgam tattoos occur when metal fillings leak, causing dark marks to appear inside the mouth.

These marks can appear when a dentist places or removes a filling and tiny metal fragments fall between the teeth.

They most commonly appear on the gum or cheek, near the amalgam filling. However, they can appear anywhere in the mouth.


Amalgam tattoos do not cause any symptoms or require any form of treatment.

Smoking can cause smoker’s melanosis. This is a condition wherein brown or black pigmentation develops inside the mouth and throat.


This condition is not harmful, and it does not require treatment.

However, the tobacco smoke that causes these spots is harmful to various areas of the body. For example, smoking can cause gum disease, tooth loss, and mouth cancer, as well as several other conditions.

Melanoma is a cancer of the pigment-making cells, or melanocytes, that typically affects the skin. However, these cancers can also occur on mucosal membranes, such as in the mouth.

Oral melanoma usually appears as a raised area that has a black, brown, or dark blue appearance. These marks can be asymmetric with an irregular border.

There may also be swelling, if inflammation is present.

One 2020 article notes that oral melanoma is not related to sun exposure. Healthcare professionals are unsure about what the risk factors may be, but they may include:

  • dental irritation
  • cigarette smoking
  • alcohol consumption


The main treatment option for oral melanoma is surgery. A healthcare professional may also recommend radiation therapy.

Addison’s disease is an endocrine disorder that occurs when the adrenal glands, which are the glands on the top of the kidneys, do not make enough of certain hormones. These include cortisol and aldosterone.

The National Institute of Diabetes and Digestive and Kidney Diseases note that Addison’s disease can cause the development of darker areas on the skin and inside the mouth.

Other symptoms can include:

  • chronic fatigue
  • muscle weakness
  • abdominal pain
  • weight loss
  • appetite loss


Treatment for Addison’s disease will include hormone replacement medications. People can take a corticosteroid, such as hydrocortisone, to replace missing cortisol. They will take an oral tablet two or three times per day.

To replace aldosterone, a person can take fludrocortisone to help balance the amount of fluid and sodium in the body.

Peutz-Jeghers syndrome is a rare genetic condition that causes dark freckles to appear around the face and inside the mouth. It may also cause mushroom-shaped tissue growths called polyps to develop throughout the gastrointestinal tract.

Peutz-Jeghers syndrome can also cause other symptoms, including:

  • nausea
  • vomiting
  • stomach pain
  • rectal bleeding
  • digestive issues


There is currently no cure for Peutz-Jeghers syndrome. However, treatments may involve surgically removing any polyps that are causing gastrointestinal problems.

A doctor or dentist will perform a physical examination of the black spots to determine the cause. Also, they will likely ask the person whether or not the spots are painful or have any accompanying symptoms.

A doctor may also check a person’s medical history for any signs of genetic conditions, such as Peutz-Jeghers syndrome, that could be the cause. They might also review the person’s dental records for the presence of metal fillings.

Depending on their assessment, a doctor may also order additional tests to make a firm diagnosis. For example, they might require a blood test or skin sample for further analysis.

Many causes of black spots inside the cheek, such as amalgam tattoos, are harmless.

Although no medical treatment is necessary for some causes of a black spot in the cheek, a person should contact a doctor about any sore or spot that lasts for longer than 3 weeks.

If the black areas develop sores or ulcers, these could be symptoms of mouth cancer. Early detection of mouth cancer is crucial for successful treatment.

There are many possible causes of black spots inside the cheek. For most people, these spots will cause no additional symptoms and will not require treatment.

Some people may require OTC treatments for causes that cause pain, such as blood blisters. Other causes, such as mouth cancer, will require medical treatment.

Although black spots inside the mouth may be harmless, it is worth contacting a doctor about persistent cases. They can help determine whether the spot is harmless or requires further care.

Spots in the mouth: what are the causes

Spots in the mouth: what are the causes | Moscow
Jump to content

  • Moscow, Sergey Makeev, 8

  • Mon-Sun – Daily, from 10:00 to 21:00

  • + 7 (495) 128-46-33





  • 8 (499) 404-31-55​