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Pigmentary incontinence may be present.1-3 Diagnoses of hyperpigmented lesions of the oral mucosa include physiologic melanin pigmentation, drug-induced skin pigmentation, oral melanocytic nevus, melanoma, black hairy tongue, oral melanoacanthoma, smokers melanosis, amalgam tattoo, postinflammatory hyperchromia, and Laugier-Hunziker syndrome (pigmentation of the oral mucosa associated with melanonychia)