Diagnosis of pigmented lesions of the oral cavity and perioral tissues is challenging. Color changes in the oral mucosa can be attributed to the deposition of either endogenous or exogenous pigments. Pigmentations can also vary depending on the quantity, depth and location of the pigment which can be of physiological or pathological in nature. This books provides an understanding of the various disorders and substances that can contribute to oral mucosal coloration and an insight into the evaluation, diagnosis and management of such conditions.