OBJECTIVE: Accurate diagnosis of pigmented lesions is important to differentiate their origin and to examine benign and malignant lesions. Dermoscopy is a non-invasive diagnostic aid that allows visualization of morphological features that are not visible to the naked eye. It is now widely used to evaluate pigmented skin lesions and for early detection of melanoma. In this study, pigmented lesions in the oral cavity and the head and neck area were evaluated using dermoscopy. MATERIALS & METHODS: This study included patients with oral, head and neck pigmented lesions who were referred to the Department of Oral and Maxillofacial Diseases of Mashhad Dental School and the Dermatology Clinic of Imam Reza Hospital in Mashhad in 2023. After obtaining the patient's consent, clinical examination and dermoscopy were performed with the DermLite Hybrid Handyscope, and in some cases histopathological examination was also performed. Finally, clinical and dermoscopic images of the patients were collected and evaluated. RESULTS: In this study, 40 patients with pigmented lesions were evaluated. Most lesion were associated with pigmented oral lichen planus (18 cases), followed by varices (8 cases) and hemangioma (5 cases). The most common dermoscopic features in pigmented lichen planus were Wickham striae with structureless pigmentation, and the most common features in varices and hemangioma were purple lacuna with fibrous white lines. CONCLUSION: According to studies, the observation of Wickham's striae, structureless brown pigmentation, dotty or globular pigmentation with or without a red background indicates pigmented lichen planus. Furthermore, the observation of lacunae (in larger lesions) and clod (in smaller lesions) in purple, red, or blue may be associated with white fibrous lines and indicates vascular lesions such as varices or hemangioma. Therefore, dermoscopy is very useful as a diagnostic aid in the examination of some oral lesions.