Black Spots on Tongue: Under, Side or Tip Causes Like Cancer & Treatments 

Have you sometimes noticed dark spots on the back of tongue and wondered what went wrong? A small black spot or dots on the tongue in humans can be benign pigments. Are these spots anything to worry about anyway?

Black patches or mere spots on the tongue need prompt attention apart from just identifying them.

In pictures

The appearance of these spots can vary with location. They may look to be small dots, marks or pigments on the tip of tongue or side or top surface. Some spots which look bumpy or raised may be a symptom of oral conditions (rare). The color shades may differ depending on what causes them or where they are likely to appear in the mouth.

Oral melanoma lesionPictures provided give an impression and provide hints on what they may look like.

What are the black spots or patch on my tongue?

I have a black spot on my tongue. Is it normal to get dark spots on tip or side of tongue? Anyone who cares about their health will want to know what happens if they woke up and suddenly noticed a black or dark red bump under the tongue.


Pigmented spots in the oral cavity can occur due to variations in melanin, melanoid, reduced hemoglobin and carotene. Pigmentation caused by increased melanin may appear as small brown, black or gray and sometimes blue (depending on the concentration and location of the accumulated amount of pigment). Why? According to a US Contemporary Clinical Dentistry, “human oral mucosal epithelium is not uniformly colored and several degrees may be observed in physiologic and pathologic conditions.” []

Pigmentation of the tongue may also appear as brown patches. Clinical history and observations have indicated that the dark pigments due to a variation or increase in melanin are not influenced by trauma or tongue injury.

Pigmentation can occur across all races and in both sexes. However, the intensity could vary with endogenous and exogenous etiological factors.

Hairy tongue signs

Presence of these spots is a characteristic manifestation of early signs of the hairy tongue as it starts out.

The common signs include hairy-like coating and a burning sensation.

Although the process on how it develops on the tongue is not very clear, clinicians point to a number of contributing factors including poor oral practices, use of certain medications and tobacco chewing or smoking.

Cases are expected to clear on their own. However, using a tongue scraper gently will help to remove the coating. Nevertheless, individuals are encouraged to get an oral diagnosis to cast away any doubts about its symptoms. The collective symptoms could literally cause a black tongue.

Injury including tongue piercing

Injury can cause small or tiny black marks on the tongue. Examples of situations that lead to injury include tongue biting, oral surgery and use of dental appliances, silver filling or teeth amalgam. The spots could as well appear under or on its lateral sides.

Besides increasing risks of oral infections, tongue piercing is a possible cause for the formation of dark pigments or spots. After the process the mouth’s mucosal irritation could result consequently leading to loss of pigment particularly at the piercing spot. The pigment formed around the piercing is expected vanish with healing and good oral care.

Oral fibroma

Oral fibroma is harmless tumor-like growths of the oral mucosa which may be hard or soft and white or pink colored. Signs of oral fibroma are well identified after a biopsy is taken from the suspected growth. After diagnosis, the growths are found to harbor fewer cells and the epithelium (lining) thinner or thickened.

Unlike cancer which develops as a result of uncontrollable and rapid cell growth, oral fibroma is normally a mass or tissue outgrowth in response to localized trauma or irritation. They may increase in size but they are not pre-cancerous.

Types of oral fibroma

A number of these oral fibromas do exist in humans but irritated oral fibroma is mostly linked to dark raised spots on mucosa of inner cheeks and the top surface of tongue. Other types include the following.

  • Epulis fissuratum
  • Sclerotic fibroma
  • Giant cell fibroma
  • Myofibroma and myofibromatosis
  • Retrocuspid papilla
  • Peripheral ossifying fibroma
  • Peripheral odontogenic fibroma

Occurrence of oral fibroma is by far less compared to cancer. (Only 1 or 2 affected in every 100 heads). Usually, oral fibromas are non-malignant and rarely develop into a kind of oral cancer.

Other causes

Outlined below are factors that can cause a change in tongue colour

  • Certain medications e.g. Bismuth Salicylate containing drugs and anti-depressants
  • Excessive tobacco chewing in addition to alcohol
  • Consumption of coffee and licorice beverages
  • Contraceptive pills in birth control especially during pregnancy
  • Immunosuppression, chemotherapy and infections that lower immunity e.g. HIV and herpes infection
  • Allergic reactions can cause sudden appearance of tongue spots
  • Anemia (rare in adults)

In infants?

Do children suffer from tongue spots? The occurrence can also be experienced in children. In most cases, parents highly suspect it to be a yeast infection. Moreover, it could be something else.

Hairy tongue papillae

This can also occur in infants and toddlers. The biological mechanism which leads to its occurrence is unclear. However, doctors think it is related to “defective desquamation and reactive hypertrophy of the filiform papillae.” []

In infants should resolve on its own without therapy. If it necessitates treatment take your baby to get diagnosed.

Certain medications

Not every medicine or oral drugs will lead to change in pigmentation of tongue or color. Some antibiotics given to young babies can interact with the these spots, green tongue and coating. Substances such as Bismuth Salicylate added to drugs are responsible. Examples of other medicines include asthma inhalers and anti-depressant pills.

Other causative factors include anemia, allergic reaction and oral thrush medication.

Is it oral cancer

Should you be worried if you have a tumor under your tongue, on the lateral border or side of tongue?

According to cancer experts of Cancer Treatment Centers of America, 90 per cent of oral cancer cases are due to Squamous cell carcinoma. Characterized by flat cells, this form of cancer affects the larynx, throat and oral mucosa including the gums and lips. The other type of oral cancer is lymphomas that causes damage to lymph tissue.

Symptoms of oral cancer

Typical oral cancer symptoms may vary from with patients affected depending on what triggers development of cancer and the type of oral cancer. Common symptoms include

  • Swelling, bumps, and lumps or spots in mouth that do not heal easily
  • Sudden bleeding in mouth especially from sores
  • Numbness in mouth or loss in feeling
  • Tenderness and swelling in neck region
  • Sore throat
  • Hoarseness in voice
  • Difficulty in swelling and talking among others

Oral melanoma – a rare cancer

Now, precancerous lesions of skin such as melanoma can develop in mouth especially the hard palate and on the tongue. Although it is rare, medical research has established the manner in which oral melanoma is caused. Its etiology (causative manner) is in genetic defects or mutations. Nonetheless, it is still unclear whether smoking or use of tobacco can cause it.

What are the symptoms? After evaluation of one real case of a patient who had this rare form of oral cancer (refer to the picture), the doctors discovered a bump or raised black tumor on tongue.

Tongue Blisters

Apart from potential oral cancer symptoms, dark spots or bumps could be blisters on the tongue. In contrast to oral cancer, these bumps are usually painful. Dark red appearance is prominent due to the presence of blood-filled blisters. If these bumps rapture they become sore and cause pain in mouth.

The blisters can be brought by accidental tongue biting and repetitive injury. Even though some causes are theorized. Blisters are not cancerous whether they form under tongue or on sides.

IMPORTANT: Purple veins under tongue is normal and has little and nothing related to cancer symptoms.

Getting rid of black spots on tongue or in mouth

Unless the black spots are signs of something with more serious health impact, treating benign small spots due to pigmentation is not necessary. Some cases are quite easy to deal with. For instance if your tongue forms a coating after taking medicines, do a gentle scrubbing or brushing to remove it.

Treatment or removal options

Do you really need to go for treatment to get rid of dark spots from mouth? Our response would be a YES or a NO. If the spots are diagnosed and evaluated your dentist will determine if they require treatment and your doctor may interrogate you to find more on symptoms i.e. if the dark bumps or spots are painful or cause discomfort.

What are the treatment forms available?

Surgical excision

A simple excision may be done by your doctor in order to know what your problem is. On the other hand a surgical excision is one of the effective methods used to remove oral fibroma tissues –only if it is actually known.

This procedure is quite simple and very safe so long as it is carried out by a certified dental expert.

NOTE: Oral fibroma tissues would not heal naturally unless they are removed or treated.


Use of antibiotics to control or treat oral infections must be approached with caution. Before using oral antibiotics talk to your dentist and inform them about your tongue problem. It is also important to know whether your symptoms keep on coming and going.

Preventing and dealing with them

If you do not practice excellent oral hygiene and care instances of oral spots recurring are more likely. Below are important health tips to help you out.

  • Cleaning your mouth at least once or twice daily through teeth brushing, tongue cleaning and flossing
  • Controlled or limited and use of appropriate mouthwashes. If you are not certain of what to use and what to avoid, kindly ask your dentist
  • Stop or quit smoking and drinking alcoholic beverages especially if you have a history of mouth sores
  • Going for regular dental check-ups, diagnosis and tongue testing
  • Healthy eating habits and good lifestyle. Avoid eating too hot foods and spicy ones as well
  • Avoid using your mouth for purposes which are not meant for
  • Follow your doctor’s advice to avoid problems especially during pregnancy