Melanocytic nevi (moles) on the vulva are relatively common. They present clinically as macules or papules of different shades of brown, sometimes pink or dark blue, occasionally black, generally with a smooth surface. Melanocytes are found in the basal layer of the epidermis, every 4th to 10th cell, as well as in hair follicles throughout the entire skin surface. Melanocytic nevi are benign neoplasms composed of nests of modified melanocytes (nevus cells) located in the epidermis, dermis, or both. The nevus cells are sometimes dendritic in appearance with vacuolated cytoplasm. They may be congenital or acquired lesions. Most nevi appear during childhood and puberty. Figure 9 demonstrates a benign nevus that is brown, located on the right labium minus. However, some lesions are pedunculated and may also contain hair.
Histologically, nevus cells may be confined to the junctional region of the dermis and epidermis (junctional nevus), dermis (intradermal nevus), or both (compound nevus), where they have a propensity to nest formation (Fig. 10). When a dermal component of nevus is present, the nevus cells become smaller and disperse from nests with greater depth in the dermis. Mitotic figures in the dermis are usually absent. Some genital nevi demonstrate atypical histologic features such as variability
in size and shape of nests and fusion of some nests resulting in confluence along the basal layer of the epidermis and cytologic atypia of nevus cells.
Observation without treatment is recommended for a stable, unchanging benign nevus. However, if change in size, shape, color, pruritus or any difference in appearance occurs, removal is recommended (Table 3).
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