History: A young adult man complained of an asymptomatic dotty brownish pigmentation of the dorsum of the tongue of many years duration. Dorsally, the tongue has three types of papillae: filliform, fungiform, and circumvallate papillae. Fungiform papillae may show physiologic, well demarcated, symmetric pigmentation of the tips of the papillae. This is usually noted in persons with a darker natural complexion and in women who are pregnant or on hormone replacement therapy.