Black patches and white spots on the tonsils are the possible causes of tonsillitis, melanoma, hemangioma and other diseases. 1. Tonsillitis: Tonsillitis is caused by infection, immunity, acute inflammation and other factors, the patient will have pharyngeal discomfort, dysphagia, halitosis and other symptoms, the patient’s tonsil crypts will have cheese-like or tofu dregs-like spoilage, in the mixing of food residues, or can be observed in the tonsils have black patches and white spots. 2. Melanoma: The cause of melanoma is still unknown, and it may be caused by factors such as fair complexion and multiple moles. It may lead to ulcers, bleeding, white or brown skin, etc. When it occurs on the surface of the tonsil mucosa, there may be black patches and white spots on the tonsils. 3. Hemangioma: Hemangioma is caused by neovascularization or abnormal vascular proliferation, and some patients will have dark red plaques or papules, which are characterized by black plaques and white spots on tonsils. When patients have the symptoms of tonsils with black plaques and white spots, they should consult a doctor in time to find out the cause and follow the doctor’s instructions for treatment.