070 (When) should we biopsy a vulvar naevus in a child or adolescent?

Abstract

Objective: Decision-making regarding pigmented genital lesions in childhood or adolescence may be difficult. These are ‘special-site’ nevi1 and generally have a benign clinical course even when seeming clinically worrisome or showing disconcerting histological signs of atypia or dysplasia [ [1] Ahn C.S. Guerra A. Sangüeza O.P. Melanocytic nevi of special sites. Am J Dermatopathol. 2016; 38: 867-878 Crossref PubMed Scopus (15) Google Scholar ], especially when the naevus is in a background of vulvar lichen sclerosus (VLS) in a juvenile [ 2 Pinto A. McLaren S.H. Poppas D.P. Magro C.M. Genital melanocytic nevus arising in a background of lichen sclerosus in a 7-year-old female: The diagnostic pitfall with malignant Melanoma. A literature review. Am J Dermatopathol. 2012; 34: 838-843 Crossref PubMed Scopus (17) Google Scholar , 3 La Spina M. Meli M.C. De Pasquale R. Perrotta R.E. Lanzafame F. Caltabiano R. et al. Vulvar Melanoma Associated with Lichen Sclerosus in a Child: Case Report and Literature Review. Pediatr Dermatol. 2016; 33: E190-E194 Crossref PubMed Scopus (17) Google Scholar ]. The clinician would like to rule out malignant melanoma. Few case studies of vulvar melanoma in juveniles have been published, and those cases reported were generally found with concomitant VLS, making histopathological analysis complex [ 2 Pinto A. McLaren S.H. Poppas D.P. Magro C.M. Genital melanocytic nevus arising in a background of lichen sclerosus in a 7-year-old female: The diagnostic pitfall with malignant Melanoma. A literature review. Am J Dermatopathol. 2012; 34: 838-843 Crossref PubMed Scopus (17) Google Scholar , 3 La Spina M. Meli M.C. De Pasquale R. Perrotta R.E. Lanzafame F. Caltabiano R. et al. Vulvar Melanoma Associated with Lichen Sclerosus in a Child: Case Report and Literature Review. Pediatr Dermatol. 2016; 33: E190-E194 Crossref PubMed Scopus (17) Google Scholar , 4 Schaffer J.V. Orlow S.J. Melanocytic proliferations in the setting of vulvar lichen sclerosus: diagnostic considerations. Pediatr Dermatol. 2005; 22 (author reply 8–9): 276-278 Crossref PubMed Scopus (13) Google Scholar ]. Studying the prevalence of malignant melanocytic vulvar lesions in juveniles could support clinicians when deciding whether or not to biopsy.