SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD
A 66-year-old woman was seen by her primary care physician for a vulval cyst. Her physician incidentally noticed an unusual pattern of pigmentation. This was asymptomatic and had gone unnoticed by the patient. There was no family history of note. Physical examination revealed hyperpigmentation of the whole vulva and perianal skin. In the vulval area it was stippled and reticulated (Figure 1) and perianally it was confluent (Figure 2). There was subtle hyperpigmentation of the upper thighs but no abnormal pigmentation in the mouth or any other site. Laboratory test results showed no abnormalities for full blood cell count; urea, electrolyte, random cortisol, or random glucose levels; or thyroid function. A punch biopsy from the left labium majus was obtained (Figure 3).
Tsakok T, Sheth N, Suchak R, Calonje E, Neill S. Reticulate Hyperpigmentation of the Vulva —Quiz Case. Arch Dermatol. 2012;148(1):113-118. doi:10.1001/archderm.148.1.113-d