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December 2000

Irregular, Pigmented Genital Macules

Author Affiliations
 

MICHAEL E.MINGMD

Arch Dermatol. 2000;136(12):1559-1564. doi:

Microscopic examination revealed increased basilar hyperpigmentation and occasional dermal melanophages. There was no significant increase in melanocyte number, and no atypical cells or inflammation was present.

The patient was reassured and will continue to be monitored for significant clinical changes.

Genital lentiginosis is an uncommon condition of pigmented genital macules that has also been referred to as penile lentigenes, atypical penile lentigenes,1vulvar melanosis,2 and melanotc macules. It typically presents in the fourth decade of life as asymptomatic, large, multifocal patches of variegated pigmentation with irregular borders on genital skin. In men, the penis, especially the glans, is most frequently involved,3 whereas in women, the vulva, vagina, or perineum may be affected.2,4 Men usually report gradual expansion of lesions over an average of 14 years before presentation. In contrast, women describe a very abrupt onset; this difference may be attributable to the greater difficulty of frequent self-examination in women.2,3 Pigmentary changes include brown, black, or blue hyperpigmentation and hypopigmentation, often with mottling and skip areas.14 Because of this atypical clinical appearance, genital lentiginosis is often confused with mucocutaneous melanoma. However, biopsy findings are invariably benign, showing mostly basilar hyperpigmentation. Other possible microscopic findings include slight epidermal hyperplasia without atypia and increased dermal melanophages, which tend to be dendritic in penile lesions.3

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