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Chapter 5: Genitalia

GENERAL INSTRUCTIONS

General Instructions:

You will find a list of True/False statements following each case history. Select any statements, which you believe to be true. There may be one, more than one, or no true statements for any given case. Choose the correct risk, diagnosis, and disposition for each case. Then, turn the page to find a detailed discussion and pearls for each case.

CASE 1

CASE 1 HISTORY

The patient was embarrassed to show this lesion to her gynecologist. She finally did after more than a year.

  1. Clinically and with dermoscopy this looks like an irritated seborrheic keratosis.

  2. Milky-red color and pinpoint vessels confirm that there is inflammation.

  3. White, pink, and blue colors in a genital lesion are red flags for concern.

  4. Pigment network confirms that this is a melanocytic lesion.

  5. This is an invasive melanoma filled with high-risk melanoma-specific criteria.

5-1a
Two photos show the pubis with a black circular lesion with a defined border. The second photo is a closer view of the lesion.
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5-1b
A photo shows a circular lesion with streaks at the border, pink, red, bluish white, and brown shades, and white network.
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RISK

  • ☐ Low

  • ☐ Intermediate

  • ☐ High

DIAGNOSIS

  • ☐ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☐ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☐ Follow-up

  • ☐ Histopathologic diagnosis

5-1c
A photo shows a circular lesion with an asymmetry of color and structure and a multi component global pattern indicated by the numbers 1, 2, 3, and 4.
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RISK

  • ☐ Low

  • ☐ Intermediate

  • ☑ High

DIAGNOSIS

  • ☐ Nevus

  • ☐ Seborrheic keratosis

  • ☐ Basal cell carcinoma

  • ☐ Vascular

  • ☐ Dermatofibroma

  • ☐ Squamous cell carcinoma

  • ☑ Melanoma

  • ☐ Other

DISPOSITION

  • ☐ No intervention

  • ☐ Follow-up

  • ☑ Histopathologic diagnosis

DERMOSCOPIC CRITERIA

  • Asymmetry of color and structure

  • Multicomponent global pattern (1,2,3,4)

  • Irregular pigment network (black boxes)

  • Irregular streaks (black arrows)

  • White/negative network (white boxes)

  • Milky-red/pink color with pinpoint vessels (red circle)

  • Bluish-white color (stars)

  • Many colors

ANSWERS

Answers: 3,4,5

Discussion:

  • Clinically but not dermoscopically this could be a seborrheic keratosis.

  • There are no dermoscopic criteria to diagnose a seborrheic keratosis.

  • The suprapubic area would be considered the trunk/extremities and not genital mucosa in terms of dermoscopic evaluation.

  • There are site-specific criteria found on mucosal surfaces that are not found on the trunk/extremities.

  • Criteria found on genital mucosa:

    • Parallel brown lines and/or globules

    • Fingerprint-like parallel line segments

    • Ring-like structures

    • Fish scale-like structures (the shape of inverted u’s and/or v’s)

    • Homogeneous, globular, and reticular patterns

    • Multicomponent, cerebriform, and polycyclic patterns

  • Dermoscopic evaluation:

    • Asymmetry of color and structure

    • Multicomponent global pattern

    • Irregular pigment network

    • White/negative network

    • Irregular streaks

    • Milky-red/pink color with pinpoint vessels

    • Bluish-white color

    • Many colors

  • The irregular streaks are associated with irregular pigment network.

    • Irregular streaks can be found alone or associated with irregular dark blotches or pigment network.

  • Pattern analysis easily diagnoses an invasive melanoma.

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