A 35-year-old white man presented with a several-year history of an asymptomatic, slowly expanding discoloration on the ventral shaft of the penis. The patient denied exposure to irritants, trauma, or other skin diseases. He was otherwise healthy and took no medications. There was no personal or family history of melanoma. Physical examination revealed a 4-cm, asymmetric, well-demarcated patch of variegated pigmentation with irregular borders (Figure 1). There was no associated erythema or surface changes. A Wood lamp examination revealed accentuation of hyperpigmented and hypopigmented areas with focal depigmentation. A punch biopsy specimen of the most darkly, irregularly pigmented area of lesional skin was obtained (Figure 2).
Hwang L, Wilson H, Orengo I. Irregular, Pigmented Genital Macules. Arch Dermatol. 2000;136(12):1559-1564. doi: