We thank Carlson and Mihm for their comments about the distinction between vulvar melanocytic nevi (VMN) and melanoma. However, it is still our opinion that the 2 cases presented in our article represent vulvar melanoma and not VMN.
In the study of pagetoid melanocytosis by Haupt and Stern,1 pagetoid melanocytes were seen in 4 (80%) of 5 cases of VMN. These cases consisted of lesions from 4 pregnant women that histologically demonstrated no cellular atypia or suprabasal lateral extension of the pagetoid melanocytes (features that Carlson and Mihm claim are frequently seen in VMN). Furthermore, cellular atypia of the pagetoid cells was seen in 22 (88%) of the 25 melanomas included in that study. In a prospective study2 of vulvar nevi, 7 (2.3%) of 301 women had VMN. Of these 7 lesions, only 1 demonstrated clinical and histological atypia. None of the other 6 VMN demonstrated clinical atypia, and histologically
Egan CA, Vanderhooft SL. Vulvar Nevi, Lichen Sclerosus et Atrophicus, and Vitiligo-Reply. Arch Dermatol. 1997;133(10):1315-1316. doi:10.1001/archderm.1997.03890460141027