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October 1997

Vulvar Nevi, Lichen Sclerosus et Atrophicus, and Vitiligo-Reply

Author Affiliations

Department of Dermatology University of Utah Health Sciences Center 50 N Medical Dr Salt Lake City, UT 84132

Arch Dermatol. 1997;133(10):1315-1316. doi:10.1001/archderm.1997.03890460141027

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