Melanosis of the vagina: A case report

BACKGROUND: Melanosis is a term given to lesions in which melanin pigment is confined to the basal layer of squamous epithelium and on visual inspection may have an appearance similar to that of malignant melanoma. Although relatively common in the oral and gastrointestinal tract, melanosis is an uncommon finding in the female genital tract and especially rare in the vagina; most reported cases have been vulvar. CASE: A 43-year-old, nulliparous woman was noted to have a pigmented lesion at the vaginal cuff during a routine annual examination one year after a hysterectomy. On physical examination, the lesion appeared as a coalescence of several small, pigmented areas at the cuff. On palpation the lesion was flat, having the contour of normal vaginal mucosa, and was not indurated or tender. A biopsy revealed vaginal melanosis. The patient was followed conservatively, with annual examinations, which documented no change in color, size or contour of the lesion. At this writing the patient is six years from presentation and doing well. CONCLUSION: Vaginal melanosis may be difficult to distinguish clinically from malignant melanoma but carries a much different prognosis. A biopsy of any pigmented lesion is always indicated prior to determining the need for therapy versus observation.