Dark-Colored (Brown, Blue, Gray, or Black) Lesions: Patches
Pigmented vulvar lesions are estimated to occur in 10–12% of the general population and account for approximately 20% of vulvar disease [1]. Vulvar melanosis is the most frequent lesion among these pigmented disorders.
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Sandra Ronger Savle
Pigmented vulvar lesions are estimated to occur in 10–12% of the general population and account for approximately 20% of vulvar disease [1]. Vulvar melanosis is the most frequent lesion among these pigmented disorders. Pigmented vulvar lesions mainly arise on the labia majora and minora and clitoris, although they can also occur at the perineum or mons pubis. They include melanocytic and nonmelanocytic proliferations. The differential diagnosis includes benign and malignant melanocytic proliferations, such as nevi and melanoma. Other entities marked by increased pigmentation include melanosis, post-inflammatory and physiological hyperpigmentation, and acanthosis
nigricans. Nonmelanocytic proliferations such as basal cell carcinoma, vascular tumors, and seborrheic keratosis can also present as pigmented vulvar lesions (Table 35.1). Vulvar nevi, melanosis, and melanoma are particularly challenging because of the similarity of their clinical and histopathological presentation. As such, they may be a cause of patient and physician anxiety and can result in unnecessary surgical procedures [2]. Pigmented lesions on mucosa and especially in genitalia are usually alarming. Very frequently, the diagnosis has to be performed by histologic examination. Dermoscopy is a helpful tool for the selection of the best site to perform the biopsy.
Table 35.1 Differential diagnosis and classification of pigmented vulvar lesions
Benign lesion
Malignant or premalignant lesion
Melanocytic lesion Melanocytic Epithelial hyperpigmentation without hyperplasia melanocytic hyperplasia Nevus Melanosis Post-inflammatory pigmentation Acanthosis nigricans
Melanoma
Nonmelanocytic lesion
Angiomas, angiokeratomas Seborrheic keratosis Papillary hidradenoma Mucous cyst, blackheads Basal cell carcinoma vHSIL
S. Ronger Savle (*) Department of Dermatology and Gynecology, Lyon 1 University and Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France © Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_35
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Dark-Colored Lesions: Breaking the Myths
• Once a vulvar pigmented lesion is detected, it causes anxiety for both patient and health-care giver. For the patient, it is especially alarming. For the health-care giver, differential diagnosis is difficult. Vulvar nevi, melanosis, and melanoma are particularly challenging because of the similarity of their clinical and histopathological presentation. These situations may result in needless surgical procedures.
References 1. Hosler GA, Moresi JM, Barrett TL. Naevi with site- related atypia: a review of melanocytic naevi with atypical histopathological features based on anatomic site. J Cutan Pathol. 2008;35:889–98. 2. Venkatesan A. Pigmented lesions of the vulva. Dermatol Clin. 2010;28:795–805.
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