By Gary M. White, MD
Vulvar melanosis (VM) is a benign lentiginous pigmentation of the female genitalia.
- This benign pigmented patch of the vulva mimics melanoma.
- Histologic examination shows increased pigmentation in the basal layer. There is no atypia.
- In one study, VM represented 68% of pigmented vulvar lesions in reproductive-aged women [JAAD 1990;23;982].
- Some cases have been associated with starting BCPs, the postpartum period, and lichen sclerosus.
- In one study of genital melanosis (both male and female), the average age at presentation was 43 years of age (range 14-78) [JAAD 2017;76;836].
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.
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.
Arch Dermatol. 1999;135(7):857-858
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