A five-month-old male infant present ed to the Department of Pediatrics at the Madras Institute of Orthopaedics & Trauma tology in Chennai, India, in June 2014 with a pigment ed lesion on the tongue that had been observed since birth. The baby was healthy, accepting feeds well and was not taking any medication. There was no associated family history of melanomas, polyposis or mucosal pigmentation. The mother reported that the size of the lesion had been increasing gradually since birth. An oral cavity examination revealed a solitary 6 x 6 mm black macule on the right lateral aspect of the surface of the tongue. There were no other pigmented lesions found anywhere else on the infant's body. A dermatological opinion was sought and a diagnosis of a congenital lingual melanotic macule was made. A biopsy was recommended; however, the family moved away and the patient was lost to follow-up. Patients with congenital lingual melanotic macules need to be followed up regularly to note any changes in the size, shape or colour of the lesion. Long-term outcomes of patients with congenital lingual melanotic macules are not known, as fewer than ten cases have been reported and the cause of origin of the lesion remains uncertain.6 There is no specific treatment for oral melanotic macules, although many researchers recommend complete excision and histological examination of the lesion.