Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.
Cancer Research "AttiliaPofferi" Foundation, Pistoia, Italy.
JAMA Dermatol. 2020 Nov 1;156(11):1185-1191. doi: 10.1001/jamadermatol.2020.2528.
Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The differential diagnosis of melanocytic lesions includes melanoma, which creates anxiety for patients and the physicians who diagnose the condition and treat the patients.
To evaluate the clinical and dermoscopic features of vulvar melanosis and their changes over time.
DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Data on patient characteristics and on both the clinical and dermoscopic features of the vulvar lesions were collected. Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits.
The clinical, dermoscopic, and histopathologic features of vulvar melanosis and their changes over time.
This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. The most frequent location for vulvar melanosis was the labia minora (55 [43%]), followed by the labia majora (33 [26%]). In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years).
This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. An association between hormonal status and vulvar melanosis may be hypothesized.
外阴黑色素沉着是一种常见的色素沉着变化，占大多数色素沉着性外阴病变。它表现为单个或多个无症状的大小和颜色不一的斑片或斑块，可能不对称，边界不清。黑素细胞病变的鉴别诊断包括黑色素瘤，这会给患者和诊断该疾病并治疗患者的医生带来焦虑。
评估外阴黑色素沉着的临床和皮肤镜特征及其随时间的变化。
设计、地点和参与者：在这项队列研究中，于 1998 年 1 月 1 日至 2019 年 6 月 30 日期间，在意大利佛罗伦萨大学皮肤科招募并随访了患有外阴黑色素沉着的患者。收集了患者特征以及外阴病变的临床和皮肤镜特征的数据。在初始评估和每年的随访就诊时，对每个病变进行临床和皮肤镜拍照。
外阴黑色素沉着的临床、皮肤镜和组织病理学特征及其随时间的变化。
这项队列研究纳入了 129 名女性（诊断时的平均年龄为 46 岁[范围，19-83 岁]），患有外阴黑色素沉着。87 名（67%）外阴黑色素沉着患者为绝经前，84 名（65%）接受过某种类型的激素治疗。外阴黑色素沉着最常见的部位是小阴唇（55 例[43%]），其次是大阴唇（33 例[26%]）。在 129 例患者中，有 39 例（30%）在初始评估后病变大小和颜色增加，但最终稳定。在中位随访 13 年（范围，5-20 年）期间，没有患者发生恶性演变。
本研究表明外阴黑色素沉着是一种良性病变，病变随时间的变化并不表示恶性转化。可以假设激素状态与外阴黑色素沉着之间存在关联。
