Pigmented Vulvar Lesions Often Require Biopsy


HOUSTON — Biopsy should be considered more frequently for pigmented lesions that appear on the vulva, compared with elsewhere on the body, because in this location they are particularly tricky to identify by appearance alone, Dr. Libby Edwards said at a conference on vulvovaginal diseases jointly sponsored by Baylor College of Medicine and the Methodist Hospital.

“It is not that pigmented lesions are likely to be more dangerous on the vulva—they are not. It's just that their appearance is less specific,” she said in an interview.

“Whereas the importance of pigmented lesions on other areas can usually be gauged relatively well by their appearance, on the vulva very abnormal-looking lesions may be unimportant and vice versa,” said Dr. Edwards, a dermatologist in private practice in Charlotte, N.C.

For example, vulvar melanosis—patchy, irregular hyperpigmentation—is a benign condition that can appear indistinguishable from vulvar melanoma.

“You have to biopsy this, it is the only way you can rule out melanoma or pigmented vulvar intraepithelial neoplasia,” she said.

Additionally, vulvar melanosis can occur as postinflammatory change associated with lichen sclerosus. “You need to treat any underlying disease, but otherwise there is no treatment for vulvar melanosis.

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