Melanotic spots of the mucous membranes L81.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 17.12.2020

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Synonym(s)

Hyperpigmentation of the oral mucosa; lentigo of the mucous membrane; lentigo of the vulva; Lentigo the glans penis; melanosis of the mucous membrane; melanotic macule (e); Melanotic mucosal spot; Melanotic spot of the mucous membrane; Melanotic spot of the vulva; Mucosal lentigo; Mucosal lentigo (e); Mucous membrane melanosis; penile lentigo; Penile melanosis; Pigmentation of the oral mucosa; Pigmentation of the penis; Pigmentation of the vulva; Pigmentation spots of the mucosa; Pigmented changes in the mucosa; Vulvar Lentigo; vulvar melanosis; Vulvar melanosis

Definition
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Acquired hyperpigmentation of the skin-near genital (lentigo of the glans penis, lentigo of the vulva), anal or oral mucous membranes, which can occur in both female and male sex. The melanotic spots of the mucous membrane, which occur in singular or small numbers, are harmless and can be interpreted as physiological pigmentation. They are observed more frequently in dark-skinned people than in light-skinned ones.

Lentiginosis of the mucous membranes can, however, also be an indication of genodermatosis (see lentiginosis below) and can occur, for example, in connection with LAMB, Peutz-Jeghers-, Laugier-Hunziker- or Cowden syndrome . In connection with the last two syndromes, it should be pointed out that lentigines of the penis may indicate a mutation in the tumour suppressor gene PTEN (phophatase and tensin homologous, deleted on chromosome 10).

Classification
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Clinical differential diagnosis of lentiginous mucosal pigmentation:

Manifestation
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No Geschlechtsbevorzung; rarely innate, usually recruited between the 20. and 60. LJ.

Localization
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Lips (especially lower lip), oral mucosa, vulva, vagina, penis, anus.

Clinical features
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Mostly solitary, rarely multiple, mostly jagged, irregularly limited, rarely rounded, also large brown or brown-black spot(s).

Histology
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Picture of lentigo simplex with basal hyperpigmentation and increase (!) of melanocytes. Often dendritic melanocytes are detectable. Subepithelial mostly clumpy pigment in melanophages.

Differential diagnosis
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Clinical:

  • See below classification; important is the differentiation to a mucosal melanoma. The latter is usually darker, sharply demarcated and always solitary.

Histological:

  • amalgam tattoos: evidence of metal deposits
  • Melanoacanthoma of the mucosa: found mainly in women of colour.
  • Melanoma in situ: disorderly proliferation of atypical melanocytes.
  • Lichen planus mucosae: in the healing phase, lichen planus mucosae may be accompanied by a scaly postinflammatory hyperpimgentation

Therapy
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Clinical and possibly histological exclusion of malignancy. A therapy is not absolutely necessary. In case of extensive melanosis cryosurgery (closed or open procedure). Regular control is important!

Progression/forecast
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Cheap.

Note(s)
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With regard to the nomenclature of melanosis, chloasma and lentigo or lentiginosis, see below. melanosis.

Literature
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  1. Cengiz FP et al (2015) Dermoscopic and clinical features of pigmented skin lesions of the genital area. An Bras Dermatol 90:178-183.
  2. Delaney TA et al (1994) Penile melanosis successfully treated with the Q-switched ruby laser. Br J Dermatol 130: 663-664
  3. Hwang L et al (2000) Off-center fold: irregular, pigmented genital macules. Arch Dermatol 136: 1559-1564
  4. Isbary G et al (2014) Penile lentigo (genital mucosal macule) following annular lichen planus: a possible association? Australas J Dermatol 55:159-161
  5. Kanj LF et al (1992) Vulvar melanosis and lentiginosis: A case report. J Am Acad Dermatol 27: 777-778
  6. Revuz J et al (1989) Penile melanosis. J Am Acad Dermatol 20: 567-570
  7. Stratigos AJ et al (2003) Lasers and aesthetic dermatology. Dermatologist 54: 603-613

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 17.12.2020