Objective To observe the effect of 810 nm Q-switched laser (QSAL) treatment on the healing rate, pain and postoperative residue in patients with oral melanotic macule (OMM). Methods The clinical data of 100 OMM patients admitted to our hospital from June 2020 to June 2023 were retrospectively analyzed. According to different treatment methods, they were divided into the QSAL group (50 patients) and the surgical excision group (50 patients). The surgical excision group underwent surgical excision, and the QSAL group received 810 nm QSAL. The healing rate, pain, postoperative residue, satisfaction and complications and recurrence during 12 months of follow-up were compared between the two groups. Results Compared with the average healing rate of the surgical excision group (3.56±0.31)weeks, the healing rate of the QSAL group was faster, reaching (2.63±0.42) weeks (P <0.05). The VAS score of the QSAL group at 7 days after operation was lower than that of the surgical excision group (P <0.05). The total satisfaction rate in the QSAL group was higher than that in the surgical excision group, and the incidence of complications was lower than that in the surgical excision group (P <0.05). There were no significant differences in the recurrence rate and postoperative PGA score between the two groups (P >0.05). Conclusion 810 nm QSAL and surgical excision have similar effects on postoperative PGA score and recurrence in OMM patients, but 810 nm QSAL can accelerate the healing rate, reduce postoperative pain, improve patient satisfaction, and lower long-term postoperative complications.