Vulvar Melanosis

The term vulvar melanosis is used when there is extensive macular pigmentation affecting the vulvar skin only (Fig. 27A and B) with the histological changes of basal hypermelanosis and a slight increase in the number of melanocytes. The etiology is unknown and the condition runs a benign but prolonged course over many years. It is

Figure 28 Acanthosis nigricans—marked hyperkeratosis and papillomatosis. Increased pigmentation is often prominent as well.
Table 15 Necrolytic Migratory Erythema

Clinical

Differential

Diagnosis

Symptoms

appearance

diagnosis

Therapy

Necrolytic

Weight loss, itch,

Erythematous

Tinea infection,

Treating any

migratory

and painful

patches that

impetiginized

underlying

erythema

rash on lower

expand out

psoriasis or

glucagonoma.

abdomen and

with an eroded

eczema

Correction of

genital area;

and scaly

nutritional

sore mouth

border. Glossitis, angular cheilitis

deficiencies

essential to have a confirmatory biopsy, because the clinical findings are frequently indistinguishable from atypical lentiginous dysplasia or even malignant melanoma (42,43).

Treatment. There is no treatment and the best management is baseline photographic documentation for self-monitoring and physician follow-up. Biopsies should be performed for any unusual changes (Table 14).

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