What Causes Brown Spots on Tongue? Symptoms, Causes, Diagnosis, Treatment

What are Brown Spots on the Tongue?

Brown spots on the tongue, also known as oral melanotic macules, are common benign lesions that can develop on the tongue. They appear as flat, brown or black spots ranging in size from a few millimeters to over 1 centimeter.

While the exact cause is unknown, doctors believe tongue spots develop from a buildup of melanin, the natural pigment that gives skin its color. Melanin can accumulate on the tongue over time due to factors like age, genetics, smoking, irritation or radiation exposure.

Oral melanotic macules are generally harmless and require no treatment. However, it's important to have any new spots on your tongue examined to rule out potential oral cancers.

Characteristics of Benign Tongue Spots

Here are the most common features of harmless brown spots on the tongue:

• Smooth, flat profile - not raised or uneven
• Distinct borders - clearly defined edges
• Uniform color - solid brown, black, grey or blue
• Size from a few mm to over 1 cm
• Can be solitary or clustered
• Occur on top or under-surface of tongue
• Asymptomatic - no pain or discomfort

Causes and Contributing Factors

While the mechanisms are not fully understood, here are some possible causes and risk factors for tongue spots:

Aging

Age is the top risk factor. Tongue spots become more common as people get older. Up to 30% of the elderly population has melanotic macules on the tongue.

Genetics

Genetics may play a role as the lesions can run in families. People with darker complexions also seem to be more susceptible.

Smoking

Tobacco use is linked to a higher incidence of tongue spots. Chemicals in cigarettes may trigger melanin production.

Irritation and Inflammation

Local irritants like tobacco, alcohol, hot foods, and spice can potentially promote spot development on areas of the tongue.

Radiation Exposure

Radiation treatment to the head, neck or mouth is another possible causative factor.

Diagnosing Tongue Spots

Brown spots on the tongue are usually diagnosed through a simple visual exam. However, your dentist or doctor may also recommend additional testing to rule out cancer or other conditions.

Medical History

Your doctor will ask about your medical history, including when the spot first appeared. They'll want to know if you have any symptoms like soreness, pain, bleeding or changes in size/color.

Oral Exam

An oral exam allows your doctor to visually inspect the characteristics of the spot including its location, size, shape and color. They will look for any worrying features like an uneven surface, irregular border, or red/white areas.

Magnification

Your doctor may use a special magnifying device to examine the spot in more detail. This helps determine if there are any abnormal cells present.

Biopsy

A biopsy involves removing a small sample of the spot to be analyzed. This is done if cancer is suspected. The biopsy confirms whether abnormal or cancerous cells are present.

Differences Between Benign Spots and Oral Cancer

While most tongue spots are benign, it's important to distinguish them from potential oral cancers. Here are some differences:

Benign Spots

• Smooth, flat surface
• Regular, distinct borders
• Uniform in color
• No pain
• No changes over time

Oral Cancer Signs

• Irregular, raised surface
• Indistinct, ragged borders
• Multicolored - red/white patches
• Pain or soreness
• Changes shape or bleeds

Any spot that exhibits unusual changes or worrisome features should be examined immediately by an oral pathology specialist.

Is Biopsy Necessary for Tongue Spots?

Most tongue spots are harmless and don't require biopsy. However, doctors recommend biopsy if:

• The spot has an atypical appearance
• It has irregular, poorly defined borders
• The surface is elevated, nodular or discolored
• It bleeds easily when rubbed
• It's rapidly enlarging or changing
• It's painful, inflamed or indurated

Biopsy is the only way to definitively rule out melanoma, oral cancer or other concerning pathology. It provides microscopic analysis of cells to check for cancer.

Treatments and Home Remedies

Most tongue spots don't need treatment since they are benign. However there are some remedies to potentially lighten their appearance:

Avoid Irritants

Stop tobacco use and limit alcohol, spices, hot temperatures that can inflame the tongue and worsen spots.

Gentle Brushing

Gently brush the tongue when brushing teeth, but avoid aggressive scrubbing which can be irritating.

Hydration

Stay well hydrated by drinking plenty of water. A moist oral environment discourages melanin production.

Lemon Juice

Some research shows daily application of lemon juice can lighten pigmented spots on the skin and tongue.

Over-the-Counter Lighteners

OTC products containing kojic acid or vitamin C may provide mild lightening of tongue spots over time.

Removal Procedures

For stubborn spots, specialists can use cryosurgery, laser therapy, or surgical scraping to remove lesions.

When to See a Doctor

You should make an appointment with your doctor or dentist if you notice:

• A new spot on your tongue
• Changes in size, shape or color
• An abnormal-looking spot
• Bleeding, pain, numbness or tenderness
• Difficulty swallowing or speaking
• Spots after radiation treatment

While most tongue spots are benign, it's important to rule out melanoma, oral cancer or fungal infections that require treatment. Don't hesitate to get any unusual spots examined.

Prevention

While not always possible to prevent tongue spots, you may be able to lower your risks by:

• Avoiding smoking and tobacco use
• Limiting alcohol intake
• Eating a healthy, balanced diet
• Practicing good oral hygiene
• Using SPF lip balm to shield from sun exposure

Getting any concerning spots on your tongue evaluated promptly can also help prevent progression to oral cancer.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.