Mucosa in Skin of Color
Oral Mucosa
Dermoscopy of mucous membranes has been named mucoscopy. At this time there are no studies that compare dermoscopy of mucous membranes from persons of color with persons of lighter skin. In fact, the literature on mucoscopy is small due to the fact that melanomas are rare on mucous membranes such as the lips, oral mucosa and anogenital regions. While squamous cell carcinoma is more common than melanoma in these regions due to HPV, there is still little written on the dermoscopy of these lesions. We will review some of the existing literature and present examples from our practice and the chapter on mucous membranes in the general area of Dermoscopedia.
In one study, benign pigmented lesions of the mucocutaneous junction and mucous membranes presented with:
- dotted-globular pattern (25%)
- homogeneous pattern (25%)
- fish scale-like pattern (18.8%)
- hyphal pattern (18.8%)
- (note the fish scale-like pattern and hyphal pattern are considered to be variants of the ring-like pattern)
Melanomas of these sites showed:
- multicomponent pattern (75%)
- homogeneous pattern (25%) [1]
In a multicenter study by the International Dermoscopy Society (IDS), the combination of blue, gray, or white color with structureless zones are the strongest indicators of malignant mucosal lesions in dermoscopy. [2]
Labial melanotic macules
Middle-aged Hispanic man with labial melanotic macule.
Note the dots, globules, and parallel lines on dermoscopy.
Middle-aged Hispanic man with labial melanotic macule.
Note the fish-scale pattern on dermoscopy.
Young Hispanic woman with labial melanotic macule.
Note the homogeneous structureless pattern on dermoscopy.
Squamous cell carcinoma of the lip
Squamous cell carcinoma of the lip and 71-year-old Hispanic man.
Dermoscopy reveals brown dots in a vertical linear arrangement along with white plaques.
Melanoma of the lip
Melanoma of the upper mucosal lip.
Dermoscopy allows for better appreciation of the blue, white, and brown areas within this mucosal melanoma.
Genital Mucosa
Benign genital
Benign nevus on the glans penis in a young Hispanic male. This was new and growing, so biopsy was performed to rule out melanoma.
Dermoscopy reveals dots and globules.
A retrospective dermoscopic study was conducted on 87 genital lesions with histopathologically proven benign melanosis.[3] The patterns found were:
- ring-like pattern (32%) characterized by multiple round to oval structures, white to tan, with dark brown, well-defined regular borders
- structureless and globular-like patterns (21%)
- parallel pattern (17%)
- cobblestone-like and reticular-like patterns (5%)
The ring-like pattern was frequently associated with multifocality and simultaneous occurrence at the labia majora and the labia minora.
Benign genital melanosis.
Dermoscopy shows a structureless pattern with subtly variegated brown pigmentation.
Benign genital melanosis.
Dermoscopy reveals a structureless pattern characterized by homogenous dark brown pigmentation.
Benign genital melanosis.
Dermoscopy shows both structureless and globular-like pattern with aggregated round to oval brown structures.
Benign genital melanosis.
Dermoscopy reveals a globular-like pattern with small aggregated dark brown structures.
Bowen’s genital
Pigmented Bowen’s disease involving the labia and perineum.
Dermoscopy shows structureless pattern consisting of multiple colors with blue-grey centrally and brown at the periphery.
Genital melanoma
Photographs from: Andreas Blum, Olga Simionescu
Mucosal melanoma of the vulva.
Dark brown homogenous pigmentation with focal white areas centrally.
A great summary chart from the Mucosa chapter in Dermoscopedia by Andreas Blum, Olga Simionescu:
| Pattern | Aspect | Signal for |
|---|---|---|
| Parallel pattern | The pigmentation is linearly distributed (wispy linear streaks) | Vulvar melanosis, in focal areas of mucosal melanoma, pigmented warts |
| Structureless (homogenous) pattern | Diffuse light to dark brown, black, grey-blue pigmented or white areas devoid of any visible structures. In white structures polymorphic vessels could be visible | Highly suggestive for melanoma, mainly in elderly people |
| Reticular pattern | Honeycomb pattern of pigmented network | |
| Dotted globular pattern | Dots and globules | Melanocytic lesions Bowenoid papulosis |
| Ring-like pattern | Do not form a complete circle (“fish scale like structures”) | Melanosis |
Links to additional chapters on Skin of Color
References
- ↑ Lin et al.: Dermoscopy of pigmented lesions on mucocutaneous junction and mucous membrane. Br J Dermatol 2009;161:1255-61. PMID: 19673880. DOI.
- ↑ Blum et al.: Dermoscopy of pigmented lesions of the mucosa and the mucocutaneous junction: results of a multicenter study by the International Dermoscopy Society (IDS). Arch Dermatol 2011;147:1181-7. PMID: 21680757. DOI.
- ↑ Ferrari et al.: The ringlike pattern in vulvar melanosis: a new dermoscopic clue for diagnosis. Arch Dermatol 2008;144:1030-4. PMID: 18711077. DOI.
