Vulvar Melanosis (VM): Symptoms, diagnosis, treatments


Vulvar melanosis (VM), also called genital melanosis or vulvar melanotic macule, is a condition that many multiple flat asymmetrical macules which characterized by a tan-brown to blue-black color, irregular borders, and variable size. It is a benign pigmented lesion that usually occurs on the labia minora, sometimes on the labia majora, perineum, introitus, vagina, and cervix.

Though current knowledge suggests that VM is a benign condition, we need follow up of all hyper pigmented vulval lesions to detect early malignant change. The clinical features of VM may be indistinguishable from those of malignant melanoma. However, vulvar melanoma is a totally different thing.

VM is just a skin condition that is not infectious. It cannot spread from one person to another during sex.



The exact cause for VM is unknown currently. There are two major related factors, including:

  • Genetic disorders
  • Lichen sclerosis – a skin disease which is characterized by white patches while are usually thinner than normal skin

Some linked genetic disorders may include:

  • LEOPARD syndrome – a very rare inherited disorder with problems in the skin, face and heart
  • Peutz-Jeghers syndrome – a genetic disorder with benign hamartomatous polyps in the GI tract, lips and oral mucosa
  • NAME syndrome – a rare condition characterized by nevi(N), primary heart tumor(A-atrial myxoma), myxoid neurofibromas(M), and freckles(E-ephelides)
  • Carney complex – a disorder characterized by an increased risk of several types of tumors 
  • LAMB syndrome – a subset of Carney complex

Systemic diseases or sunlight are not related to VM.



VM is characterized by a distribution of brown to black pigmentations that are multiple, flat distinct and stable. They don’t change the thickness of the skin.

Some familiar symptoms of VM may include:

  • Pigmented vulvar skin lesions or spots.
  • Presence of melanotic macules in another area such as genital tract.
  • Blue-black or dark brown pigments with irregular borders.
  • The macules are often singular or multiple.
  • Usually, there is no change in thickness or texture of the skin.
  • The macules may persist for years and some may not be differentiated from a melanoma, a skin cancer type.
  • Normally, this condition does not have a substantial melanocytic proliferation, nesting pattern of melanocytes, or melanocyte atypia.
  • When it comes to size, the size of various types often varies although general range tends to be between 1 -15 millimeters in diameter.
  • They have structureless and parallel pattern in vulva location.



It is important to identify VM, because overdiagnosis of it as malignant melanoma may result in needless radical surgery.

The diagnosis of VM may include the following procedures:

  • Have a complete physical examination and evaluate patient’s medical history and family history.
  • Wood’s lamp examination: Using ultraviolet light to examine the change in skin pigmentation.
  • Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination to rule out other similar conditions.
  • After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis.



Patients can have an excisional vulvar biopsy to completely get rid of the darkened small area. In case of large darkened areas, an incisional biopsy may be carried.

Periodic inspection is required to prevent other possible problems such as secondary infections after biopsies.



Patients with VM may exerted emotional stress and even develop cosmetic concerns. The stress may emerge more skin conditions that can be very severe than VM.

At the same time, the appearance of pigmented macules may induce panic of melanoma which is a type of skin cancer.

In addition, complications may spring from the related genetic syndrome. These genetic disorders may develop symptoms that may be very dreadful.

Please consult your doctors for your treatments.

Keywords: vulvar melanosis; VM; melanoma.

* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.