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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
• 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
• Pigmented nevi of genitalia maybe different
from other nevi
• Rare

Benign Melanoma Pigmented Nevi
Case Studies - Case 1

• Nevus of the Vaginal

• Pigmented compound
melanocytic nevi
• Background of lichen
Case Studies - Case 2
• Labial Pigmented
Nevus- Lentiginous
compound nevus with
moderate cytological
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
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
c)suprabasal melanocytes
d)pleomorphic confluent melanocytic
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
• 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
• 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
Melanocytic nevi on or near genital
• 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

Poor lateral circumscription of

melanoma in the dermis of
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
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
Pigmented lesions with the following features
should be excised or biopsied:

• Recent enlargement
• Darkening
• Bleeding
• Ulceration
Melanocytic nevi on or near genital
• 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
• Thus, a preference for complete excision exists, a
surgical margin around the lesion is also