A 56-year-old Hispanic woman sought an evaluation of multifocal pigmentation of lip and oral mucosa. The patient first noticed a lesion on her lower lip in 2012, followed by the development of the intraoral lesions in 2019. She stated that she was unhappy with the appearance of the lip and gingival macules. Her medical history included systemic lupus erythematosus (SLE) diagnosed in 2012, rheumatoid arthritis diagnosed in 2018, hypertension, anemia, and seizures. Her medications included hydroxychloroquine, losartan, duloxetine, gabapentin, and prednisone (as needed).