Do you notice a black spot inside your cheek?

It could be a sign of something serious like mouth cancer or it could also be harmless hyperpigmentation inside the mouth.

So it may not be dangerous at all, however, it is certain that you should not ignore it.

This article discusses the causes behind the appearance of a dark dot or spots present inside your cheek.

Keep reading to know if it is something worrisome and visit your doctor soon.

black spot causes

Black Spot Causes

Melanotic Macules

The melanotic macules are hyperpigmentation areas about 0.04 inches in diameter.

These are flat spots that also have a diameter.

However, they are not cancerous but your doctor may carry out a biopsy to rule out the possibility.

It can also be found on the tongue and palate.

Blood Blisters

These are raised sacs filled with fluid.

They can appear inside your cheek when you accidentally bite it when the skin inside the cheek is pinched or due to an allergic reaction.

The blisters are between purple or dark red in color.

While they can grow on any part of your body, the blisters are often present in the soft parts of your mouth.

Hence, they will grow on your inner lips and cheeks.

Blood blisters are big enough to touch and feel with your tongue.

Moreover, they pain when you touch them or irritate the blisters by eating spicy foods.

However, most of these do not last long if you simply leave them alone.

You will not need specific treatment for them.

Though, if they keep happening for long, exceeding 2 weeks then it is a good idea to visit your doctor once.

Also, consider a medical checkup if this persists beyond 2 weeks.

Smoker’s melanosis 

Excessive smoking can cause a smoker’s melanosis.

This condition leaves blotchy stains inside your cheeks, gums also throat.

Almost 22 percent of smokers will develop these black or brown spots in their mouth.

They do not cause any symptoms or need treatment. So it is not that serious.

Your doctor may recommend a biopsy to clear suspicion regarding any cancer.

However, if you want to get rid of these, you will need laser or electrosurgery.

Plus, if you want to prevent them from occurring, quit smoking, to protect your oral health.

causes for dots

Reasons for Dots and Spots Inside Mouth

Oral Nevi 

Nevi refer to moles.

These are black, bluish-gray or brown spots that appear inside your mouth.

They are present on the roof of the mouth and inner lip.

Though, sometimes they form on the inside of the cheeks too.

While they are slightly raised, they do not cause any symptoms or are harmful.

So there is no need for treatment.

Neither are they cancerous.

However, your doctor can suggest getting a biopsy to look into it and confirm that it is indeed a nevus and not melanoma. More on that later!

Tooth Filling Leakage/ Amalgam Tattoo 

Tooth fillings use amalgam.

Amalgam itself is made from mercury, zin, copper, tin and silver.

Amalgam tattoos appear on the inside of the cheek when these fillings leak.

These dark metals give the spot its color which is usually dark blue, black or gray.

You will find them near the filling and they are quite common.

The leakage occurs during the process when the dentist is placing or removing a filling.

During this time, the small metal fragments can fall between teeth.

While they will most probably be next to the filling, that means on the gum and cheek, the metal fragments can fall elsewhere in the mouth too.

That said, they are harmless and do not pose any other symptoms.

The tattoos will remain in place unless you get laser surgery to remove them.

oral cancer

Serious Causes of Black Spot Inside Cheek

Oral Cancer 

The melanocytes in your skin make pigments.

Melanoma is the cancer of melanocytes.

It is a raised spot with a brown, black or blue color.

However, it may also be unpigmented or white in the early stages.

These usually are not symmetric and also have a border albeit an irregular one.

In the latter stages, swelling, bleeding, pain and also ulcers may develop.

Certain risks for this disease include smoking, alcohol consumption and dental irritation.

It is more common in men than women and also the average age of diagnosis is around 56.

dark patch in cheeks

Addison’s Disease 

This disease results from a lack of hormones made by the adrenal glands.

There can be a deficiency of hormones such as aldosterone and cortisol.

As a result, darker blotches of skin form in your mouth.

Other symptoms can also develop over time such as a loss of appetite resulting in weight loss.

Moreover, you will feel fatigued, have abdominal pain and also suffer from muscle weakness.

You may suffer from low blood sugar levels, hyperpigmentation and sudden salt cravings.

A rebalance of the hormones through medications eases the symptoms and the hyperpigmentation inside the mouth.

Peutz-Jegherz Syndrome 

This syndrome is a genetic condition whereby noncancerous polyps grow inside your stomach and the intestines.

However, another symptom usually in children disappears gradually with age.

It is the presence of dark spots or freckles on the face, lips, in their mouth, near the eyes and nose as well as around their anus.

Along with that, there will be other symptoms due to the polyps in the gastrointestinal tract.

This includes nausea, pain, bleeding, vomiting and digestive issues.

You can remove the polyps in the gastrointestinal tract with surgery, however, not the pigmentation it causes in the mouth.

diagnosing black spot

Diagnosing The Problem

Since the issue can be harmless or harmful, do not take it lightly.

Consult your doctor when you see a black spot and is also painless.

While there are harmless reasons behind the growth, you should get a medical checkup if it persists beyond 2 to 3 weeks.

Usually, the harmless sores such as blood blisters will disappear on their own.

However, it is reoccurring frequently then that is also a sign of concern.

You should take things more seriously if you are older than 55 years old.

The chances of getting oral cancer are rare but older adults are more susceptible to it.

Plus, it is also important to look for sores, ulcers, pain and bleeding.

If the black area develops sores that could be a symptom of mouth cancer.

It is best to diagnose oral cancer at the earliest like any other cancer to begin treatment timely.

In order to diagnose it, your doctor will run a few tests to eliminate the possibility of oral cancer.

Physical Checkup 

Your doctor first carries out a physical inspection in order to see the spots and whether they are painful.

They can identify if it is harmless or harmful by only looking at it.

If you recently had a filling procedure then your dentist can also possibly identify it by checking your dental records.

They will also take your medical history to find if you have a genetic disease such as Peutz-Jeghers syndrome.


It is important to rule out melanoma.

Hence, your doctor will most probably carry out a biopsy if they have any suspicions.

They will cut a small piece of the dark spot and send it to a laboratory.

Blood Test 

If they suspect Addison’s disease, then they will carry out a blood test checking for hormone levels.


Treatment of Black Spot

Every cause has its own individual treatment.

For some conditions, you need to simply wait and do nothing until it goes on its own.

Others do not require any treatment or need an extensive one.

  • Blood Blisters: These usually go on their own as they are harmless, as long as you do not irritate them. However, there can be pain and discomfort. Hence. you can apply OTC gels or use a pain relief medication to soothe it a little.
  • Smoker’s Melanosis: It is a harmless condition that does not require treatment. You can remove the spot using electrosurgery and laser treatment.
  • Oral Nevi: The nevus too are harmless and do not need any specific treatment. However, your doctor may recommend getting a biopsy to eliminate the doubt of cancer.
  • Amalgam Tattoo: You will not require treatment for an amalgam tattoo. Though, if you do not remove the tattoo with laser surgery, then it will remain permanent.
  • Oral Cancer: It needs swift treatment depending on your condition. The condition can worsen rapidly. Your doctor can suggest what treatments from surgery, radiation, immunotherapy and drug therapy you will require. The main treatment is usually surgery though you may also require radiation.
  • Addison’s Disease: Medicines can regulate the levels of deficient hormones. Hormone replacement medications such as hydrocortisone and fludrocortisone can make up for missing cortisol and regulate the amount of sodium and fluid to make up for aldosterone respectively.
  • Peutz-Jeghers Syndrome: A surgery can remove the polyps in the digestive tract. However, there is no treatment for the dark freckles it causes.


If the black spot inside your cheek persists, get it checked timely.

It is much easier to treat diseases timely than delay them, especially in the case of cancer.

So contact your doctor soon if you see any symptoms.