Vulvar Melanosis

During a routine examination, macular dermatitis with irregular borders was noted on the genitalia of an otherwise healthy 41-year-old woman. The right labia minora featured a 7-cm dark pigmented macular area; a similar area measuring 10 cm was observed on the left upper labia minora.

Vulvar melanosisSMQ-8212-SMQa benign, harmless, unilateral or bilateral patchy pigmentation of the vulvaSMQ-8212-SMQwas diagnosed. Drs Eduardo Scholcoff and Steven J. Jereb and Patricia Taylor, MS, RN, FNP, of Rockford, Ill, report that the differential diagnosis includes melanoma, vulvar nevi, Bowen disease, vulvar intraepithelial neoplasia, hemangiomas, and vascular tumors. Histologic examination can distinguish vulvar melanosis from melanoma and rule out the other diseases in the differential. Biopsies of both lesions were obtained; squamous hyperplasia and fibrosis were revealed in the right labia minora, and melanosis without atypia was found in the left. Similar lesions may occur on the penis.

The patient will be followed up annually to detect any changes in the size, pattern, and color of the lesions, which may signal malignant transformation. No further treatment was needed at this time.