A 40-year-old woman with no past medical history of interest presented with asymptomatic genital lesions that had been noticed by her partner. It was not possible to determine how long they had been there. Physical examination showed no alterations to the external genitalia (Fig. 1A), but large areas of the inner aspects of the labia majora and minora and the vaginal introitus featured brown, gray, and black macules with irregular borders (Fig. 1B). Examination with the aid of a speculum ruled out internal lesions and the rest of the physical examination was unremarkable. Examination of 3 biopsy specimens taken from different sites ruled out malignancy and confirmed a diagnosis of extensive vulvar melanosis. Vulvar melanosis is an uncommon entity that accounts for 68% of all pigment alterations of the vulva in women of childbearing age. Its etiology is unknown but it has been described in association with pregnancy, oral contraceptive use, lichen sclerosis, and human papillomavirus infection. It typically presents as solitary or multiple dark macules with poorly defined borders and a predilection for the mucosal surfaces. A histologic study is necessary to rule out melanoma. Although vulvar melanosis does not appear to be associated with an increased risk of melanoma, periodic clinical and photographic follow-up is recommended.

Figure 1

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