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Background: Labial melanotic macules (LMMs) are benign pigmented lesions that usually take the shape of flat asymmetrical macules with tan-brown to black color and variable size. Whereas the dermoscopic features of other pigmented skin lesions have been relatively well described, little is known about LMMs. Objective: To describe the dermoscopic features and find typical and schematic dermoscopic patterns in LMMs. Methods: A retrospective dermoscopic study was conducted on 80 lesions with histopathologically proved LMMs. Results: We described and defined, for the first time to our knowledge, landscape painting patterns found in 65 of 80 melanotic lesions (81.3%), characterized by parallel lines or circle lines, overlapping vessels with background brown pigmentation. The background brown pigmentations were observed in 74 of 80 lesions (92.5%), the parallel lines in 62 (77.5%), the circle lines in 20 (25.0%), and overlapping vessels in 69 (86.3%). The structureless black pigmentations were only presented in 26 of 80 (32.5%). Conclusion: Dermoscopy can be useful for the clinical detection of LMMs, and “Landscape painting patterns” may represent a dermoscopic clue for the diagnosis of these lesions.