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Melanocytic Nevi of the Genitalia in

Boys and Girls: True Atypia or Site


and Age Related Phenomena?
Rahim Khan
Genital Pigmented Nevi
• Genital melanocytic nevi found on children,
viewed as potential sources of melanoma or
malignancy, are typically benign tumors of
melanocytes.
• Misdiagnosis of a benign neoplasm as
melanoma can affect a patient profoundly
• The question of how to best manage these
lesions is often raised
What is a Nevi
• Melanocytic nevi, are benign tumors of
melanocytes
• Pigmented nevi of genitalia maybe different
from other nevi
• Rare

Cancerous
Benign Melanoma Pigmented Nevi
melanoma
Case Studies - Case 1

• Nevus of the Vaginal


Introitus
• Pigmented compound
melanocytic nevi
inflamed
• Background of lichen
sclerosis
Case Studies - Case 2
• Labial Pigmented
Nevus- Lentiginous
(genital-type)
compound nevus with
moderate cytological
atypia
Case Studies - Case 3
• Nevus of Inner Foreskin
and Glans Penis
• Compound Nevus,
Glans Penis- Junctional
Nevus within
lentiginous growth
Melanoma – Diagnostic Criteria
Gross Features
1.General Architectural
Features
a)Asymmetry
b)Dimension greater than
6 mm
c) Irregular Color
d) Irregular Borders
Melanoma – Diagnostic Criteria
Histologic Features
Epidermal Features
a)poor circumscription of the
melanocytic proliferation
b)single melanocytes predominating over
nests
c)suprabasal melanocytes
d)pleomorphic confluent melanocytic
nests
Dermal Features
a)band-like inflammatory infiltrate
b)lack of maturation of melanocytes with
the progressive descent into the dermis
Cytological Features
a)melanocytic atypia
b)mitotic figures
c)necrosis of melanocytes
Melanocytic nevi on or near genital
skin
• Melanocytic nevi on or near genital skin have
often been mistaken for melanoma
– Most of these unusual genital nevi have been
noted in premenopausal women, but they occur
in men as well.
– In contrast, vulvar melanomas have a peak
incidence in older women.
Melanocytic nevi on or near genital
skin
• Most of melanocytic nevi have the architectural features of
dysplatic or Clark's nevi
– only involve the epidermis and papillary dermis
– junctional nests extend laterally beyond the dermal
component.
Melanocytic nevi on or near genital
skin
• Some genital nevi are indistinguishable from Clark's or dysplastic nevi at
other sites.
• The ones that pose diagnostic problems
– have junctional nests composed of cells with abundant pale cytoplasm
– sometimes have dense lymphocytic infiltrates.

Genital Nevi Dysplastic Nevi


Features To Help Distinguish Genital
Nevi From Melanoma
• Symmetry
• Especially challenging if dense lymphocytic
infiltrates (situations where the lesion is in a
background of lichen sclerosis or balanitis
xerotica obliterans )
Features To Help Distinguish Genital
Nevi From Melanoma
• Lateral Circumscription
present in dermis of
Nevi

Poor lateral circumscription of


melanoma in the dermis of
melanoma
Features To Help Distinguish Genital
Nevi From Melanoma
• Maturation of the
dermal component in
genital nevi
• Melanocytes with large
nuclei are seen in the
dermal component.
• Usually these larger
cells are arranged singly
or are in clusters along
with smaller
melanocytes.
Melanoma Risk factors
• Sun exposure
• Family and personal history
• Fair skin
• Increased numbers of melanocytic nevi
• Immunosuppression
• Occurrence of lentigo maligna
• Large congenital melanocytic nevus
• Dysplastic nevus syndrome
Malignancy Risk Factors

• Change in size
• Irregular change in color, especially spread of
red, white, and blue pigmentation to
surrounding normal skin
• Change in surface characteristics, consistency,
or shape
• Signs of inflammation in surrounding skin,
with possible bleeding, ulceration, itching, or
tenderness
Pigmented lesions with the following features
should be excised or biopsied:

• Recent enlargement
• Darkening
• Bleeding
• Ulceration
Melanocytic nevi on or near genital
skin
• Location of genital lesions complicates discovery,
and continued observation.
• No evidence that genital melanocytic nevi differ
from similar nevi, in other locations of the body,
in terms of malignant potential.
• Lesions may not be homogenous, both benign
and malignant areas represented in the same
lesion.
• Thus, a preference for complete excision exists, a
surgical margin around the lesion is also
important.