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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a dual-board-certified dermatologist with over 90 research publications in peer-reviewed scientific journals.

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Vulvar Melanosis: An In-depth Look at Causes, Diagnosis, and Management

Updated: Feb 23

Vulvar melanosis often sparks concern due to its appearance but is typically a benign pigmented lesion. This comprehensive guide will walk you through the intricacies of vulvar melanosis, from its causes to its management.


Flower being used as a metaphor for vulvar melanosis

Table of Contents

What is Vulvar Melanosis?


Vulvar melanosis is a benign condition marked by hyperpigmented patches on the vulvar skin. Though usually harmless, its resemblance to malignant lesions like melanoma makes proper diagnosis imperative.


Causes and Risk Factors


The exact cause of vulvar melanosis remains unclear. However, some proposed factors include:

  • Hormonal changes: Shifts in hormones, especially during pregnancy or while using birth control, may lead to pigmentation changes.

  • Friction: Constant friction in the vulvar region can contribute to pigmentation.

  • Aging: As with many skin changes, age can determine the development of vulvar melanosis.

Symptoms & Appearance


Typically, vulvar melanosis presents as:

  • Flat patches

  • Brown to black in color

  • Irregular borders

  • Varying sizes

It's important to note that these lesions are usually painless and non-raised. Any itching, bleeding, or elevation might indicate a different condition.


Differential Diagnosis


Given its appearance, it's crucial to differentiate vulvar melanosis from more concerning conditions like:

  • Melanoma: A type of skin cancer that can appear similarly but is malignant.

  • Post-inflammatory hyperpigmentation: Results from skin trauma or inflammation.

  • Other benign moles or lesions: Some may resemble vulvar melanosis but have different characteristics.

Diagnostic Procedures


If you or your healthcare provider suspect vulvar melanosis, the following steps can confirm the diagnosis:

  • Visual examination: The first step in diagnosing.

  • Dermoscopy: A non-invasive tool providing magnified, illuminated views of skin structures.

  • Biopsy: In ambiguous cases, a small tissue sample might be taken for histological examination.

Management


Vulvar melanosis is not a disease. As is the case with other parts of the body, people with darker skin tones will experience vulvar melanosis more than others. In most cases, counseling is the only management option. After all, it's a natural change in color.


However, if the color change deeply concerns you and affects you psychologically, you can discuss the treatment options with your dermatologist or gynecologist. Vaginal rejuvenation is an option that might be suggested. However, do note that the improvement might not be complete.


When to Consult a Dermatologist

It's always wise to consult a dermatologist for:

  • New or changing pigmented lesions

  • Concerns about the appearance of the lesion

  • Seeking treatment options for cosmetic reasons

Conclusion

Vulvar melanosis, though typically benign, can be a source of concern due to its appearance. Proper diagnosis is essential to rule out malignancies. If your partner is suffering from this condition, assuage them and encourage them not to worry about it. An analogous condition that occurs in males is called penile melanosis. If you notice any changes or have concerns about any pigmented lesion on the vulva, always seek the guidance of a board-certified dermatologist.

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