A 28-year-old Haitian woman asked for the removal of a small growth on the tip of her tongue. A 3 × 4-mm pale papule on the tip of her tongue was excised with a scissors snip and found to be an oral fibroma. The patient also had groups of dark papillae on the tip and anterolateral aspects of the dorsal surface of the tongue (Figure 1). She reported that the dark spots had been present as long as she could recall. She was otherwise healthy, had never used tobacco, and was taking no medications. A photomicrograph of a hematoxylin-eosin–stained hyperpigmented papilla is shown in Figure 2 (low power, left; high power, right).