Pigmented lesions, including melanomas, of the mucous membranes of the head and neck are far outnumbered by their counterparts in the skin. This relative dearth is partially responsible for the fact that scientific inquiry into mucosal melanomas has not kept pace with the advances in knowledge of the pathogenesis of cutaneous melanomas and their diagnosis and treatment. Integral to these latter advances have been the refinements in clinical and histologic classification and clinicopathologic correlations with quantitative evaluation of melanomas of skin-enhancements that up to now have been singularly lacking for mucosal melanomas. This report acknowledges this slowness in progress, present recommendations for purifying the nomenclature of pigmented lesions of the mucosae, and at the same time, also notes the poorer prognosis for melanomas of the upper aerodigestive tracts, as a group, when compared with cutaneous melanomas. Only prospective studies will answer the question of whether the poor prognosis is intrinsic to these mucosal melanomas or whether delay in detection and removal are responsible.