VULVAR MELANOSIS

By Gary M. White, MD


Vulvar melanosis (VM) is a benign lentiginous pigmentation of the female genitalia.

Clinical

Multiple, black, pigmented macules and patches of the vulva are characteristic. They may be large, irregular in shape, and variegated in color, thus making melanoma a consideration. Multifocal malignant melanoma arising in vulvar melanosis has been reported, but in general, it is unclear if VM conveys any higher risk for vulvar melanoma.

Treatment

In general, biopsy is highly recommended to confirm the diagnosis. If the clinical picture is consistent with VM, then close followup, aided with photography/imaging is a reasonable approach. Any new worrisome focus should be biopsied. The onset of a pigmented lesion in an elderly woman should raise suspicion for melanoma as vulvar melanosis is rare in women of advanced age. A complete skin exam should be performed to exclude melanoma elsewhere.

References

JAAD 2014;71;1241

Arch Dermatol. 1999;135(7):857-858

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