Abstract
Vulvar melanoma is a rare and deadly cancer in women, and the prognosis is often poor. There are limited studies on the dermoscopic features of vulvar melanoma. Described criteria include the presence of blue, gray, or white colors. Herein we present the clinical and dermoscopic characteristics of a hypopigmented and heavily pigmented nodule in a 92-year-old and an 80-year-old woman. Dermoscopy in the former revealed structureless milky-red to white areas, remnants of brown pigmentation at the base and polymorphic vessels, while the latter displayed structureless blue-gray areas with black dots and peripheral lines at the base. In both cases, histopathology revealed a stage III melanoma. Our two cases along with a review of the literature suggest that the dermoscopic features described for diagnosing cutaneous nodular melanoma, apply also for vulvar melanoma. Clinicians should always raise the suspicion if observing plaques or nodules with a dermoscopic polymorphic vascular pattern and blue-black color on the genitals of postmenopausal women.
Highlights
Vulvar melanoma (VM) is the second most common vulvar malignancy, but represents less than 1% of all melanomas and 1.0% to 2.3% of all melanomas in women [1]
VM is associated with a poor prognosis
Dermoscopy improved the early diagnosis of melanoma, but little is known about the dermoscopy features of melanoma of the vulva [4]
Summary
Vulvar melanoma (VM) is the second most common vulvar malignancy, but represents less than 1% of all melanomas and 1.0% to 2.3% of all melanomas in women [1]. The reported five-year survival rates are less than 60% [3] It is unclear if the poor prognosis of VM is due to delayed detection or a highly aggressive biological behavior, but early identification and intervention may improve patient outcomes. A 92-year-old Caucasian woman was referred to our skin cancer unit because of a bleeding nodule on the right periclitoral region. An 80-year-old Caucasian woman was referred to our skin cancer unit with a rapidly growing nodule on the right side of the labium majus. An ulcerated, blue-black nodule measuring 3 cm in diameter was seen. Dermoscopy revealed structureless blue-gray areas, black and brown dots, and some streaks at the periphery. Inguinal lymph node metastases were present, and she died few months thereafter from metastatic melanoma
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