The Ringlike Pattern in Vulvar Melanosis

Abstract

Background: Vulvar melanosis is a benign pigmented lesion that may clinically mimic melanoma. Whereas the dermoscopic features of other pigmented skin lesions have been extensively described, little is known about vulvar melanosis.Observations: A retrospective dermoscopic study was conducted on 87 lesions with histopathologically proved melanosis. We describe and define, for the first time to our knowledge, a ringlike pattern, found in 28 of 87 melanotic lesions (32%), characterized by multiple round to oval structures, white to tan, with dark brown, welldefined regular borders. The structureless and globularlike patterns were observed in 18 of 87 lesions (21%), the parallel pattern in 15 (17%), and the cobblestone-like and reticularlike patterns in 4 (5%). A significant association was found between the distribution of multifocal lesions showing a ringlike vs a nonringlike pattern (82% vs 52%; P =.008), whereas a weak association was found between anatomical site and the different patterns (P=.55). The ringlike pattern was frequently combined with multifocality and simultaneous occurrence at the labia majora and the labia minora. Conclusion:Dermoscopy can be useful for the clinical detection of vulvar melanosis, and the ringlike pattern may represent a new dermoscopic clue for the diagnosis of this lesion.

Dermoscopic and Clinical Features of Pigmented Skin Lesions of the Genital Area

“…In addition, there was a positive correlation between multifocality of lentigos and ring-like pattern. This result is consistent with Ferrari et al 10 …”

“… 9 In a larger case series, globular-like and parallel, reticular-like, cobblestone-like and ring-like patterns, and their relation with multifocality were also described in melanosis. 10 In our study, the most typical pattern of melanosis in genital localization is the 'parallel pattern'. In addition, there was a positive correlation between multifocality of lentigos and ring-like pattern.…”

Dermoscopy of Pigmented Lesions of the Vulva: A Retrospective Morphological Study

“…Previous studies highlight that a uniform brown color (the homogeneous or structureless pattern), and ring-like (the most frequent pattern observed in our previous study), fish scale, hyphal and parallel/fingerprint patterns may be confidently used in the noninvasive diagnosis of mucosal melanotic macules with a low risk of misclassification of melanoma [14,15,20]. However, melanotic macules may sometimes exhibit a blue-white veil [13,14]. Because this blue-white veil is also seen in melanoma, we recommend biopsy of any solitary or palpable vulvar lesion exhibiting dermoscopically a blue-white veil (fig.…”

Vulvar Melanocytic Nevi: A Dermoscopic Investigation

“…One junctional lentiginous melanocytic nevus showed a parallel pattern (fig. 5) indistinguishable from those found in vulvar melanosis, in which pigmentation is arranged according to the furrows and reliefs of the mucosal surface [4]. In contrast, a homogeneous pattern associated with milia-like cysts was observed in the second junctional lentiginous melanocytic nevus examined (fig.…”