10.5826/dpc.1201a14
text/xml
2160-9381
1675
en
Valeria Gaspari
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
penis
Penile Exogenous Pigmentation Mimicking Melanoma
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-02-05
2022-02-02
2022-02-09
e2022014
Dermatol Pract Concept
Valeria Gaspari
2022/02/02
10.5826/dpc.1201a14
e2022014
Dermatology – IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) – Alma Mater Studiorum University of Bologna, Italy 
2160-9381
penis
en
e2022014
Anthony EP, Godbolt A, Tang F, McMeniman EK. Malignant melanoma disguised in a tattoo. Australas J Dermatol. 2015;56(3):232-233. DOI: 10.1111/ajd.12219. PMID: 26201372.
Penile Exogenous Pigmentation Mimicking Melanoma
https://dpcj.org/index.php/dpc/article/download/1675/1467
                    Dermatology Practical & Conceptual


            Penile Exogenous Pigmentation Mimicking
                           Melanoma
            Sabina Vaccari1, Michelangelo La Placa1, Alessia Barisani1, Rossella Lacava1,
                         Cosimo Misciali1, Giulio Tosti2, Valeria Gaspari1


1 Dermatology – IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) – Alma Mater
  Studiorum University of Bologna, Italy
2 Division of Melanoma Surgery, Sarcoma and Rare Tumors, IRCCS, Istituto Europeo di Oncologia, Milan, Italy



Key words: penis, mucosal, exogenous, pigmentation, melanoma
Citation: Vaccari S, La Placa M, Barisani A, et al. Penile exogenous pigmentation mimicking melanoma. Dermatol Pract Concept.
2022;12(1):e2022014. DOI: https://doi.org/10.5826/dpc.1201a14
Accepted: May 6, 2021; Published: January 2022
Copyright: ©2022 Vaccari et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Alessia Barisani, MD, Dermatology – IRCCS Policlinico di Sant’Orsola, Department of Experimental, Diagnostic
and Specialty Medicine (DIMES) – Alma Mater Studiorum University of Bologna, Italy. Email: alessiabarisani@gmail.com




Introduction                                                                  Videodermoscopy (FotoFinder dermatoscope, Fotofinder
                                                                         Systems, GmbH) showed a multicomponent pattern with
The diagnosis of mucosal pigmented lesions can be challeng-              an uneven pigmentation, multiple irregular brown-to-black
ing, as several differential diagnoses, including benign nevi,           dots, a blue-whitish veil and polymorphous vessels with some
melanosis, melanoma, as well as post-inflammatory and                    linear vessels at the periphery (Figure 1, B and C).
physiological pigmentations, should be acknowledged. We                       The main diagnostic suspicion was penile melanoma, due
report a case of penile exogenous pigmentation clinically and            to the clinical and dermoscopic aspect and the patient’s age;
dermoscopically mimicking a malignant melanoma.                          therefore, a skin biopsy was performed for confirmation.
                                                                         Histopathological examination revealed epithelium hyperpla-
                                                                         sia, sclerosis and brownish-black pigment in the superficial
Case Presentation
                                                                         chorion, with no evidence of atypical melanocytic prolifera-
A 65-year-old Caucasian man was referred to our atten-                   tion, suggestive of exogenous pigment (Figure 2, A and B).
tion because of an asymptomatic flat pigmented lesion of                 Immunohistochemistry was negative for S-100 and MART1,
the penis. He reported that the lesion had appeared about                excluding a melanocytic neoplasm.
6 months earlier. Four years before, he had been diagnosed                    On the basis of the histopathological findings, a diagnosis
with genital lichen sclerosus and had undergone circumcision.            of penile exogenous pigmentation in association with lichen
Clinical examination revealed a brown pigmented asymmet-                 sclerosus was made. We hypothesize that the lesion was a
rical flat lesion with irregular borders on the glans and the            self-induced tattoo, even though the patient, suffering from
adjacent shaft (Figure 1A).                                              a psychiatric disorder, did not confirm this hypothesis.



Research Letter | Dermatol Pract Concept. 2022;12(1):e2022014                                                                          1
                                                                        Figure 1. Penile exogenous pigmentation in a 65-year-old Cauca-
                                                                        sian man. (A) Clinical presentation of the lesion reveals a brown
                                                                        asymmetrical flat lesion with irregular borders. (B) Videodermos-
                                                                        copy shows a multicomponent pattern with uneven pigmentation,
                                                                        multiple irregular brown-to-black dots, a blue-whitish veil and
                                                                        polymorphous vessels, circle, original magnification ×20. (C) Ar-
                                                                        row, original magnification ×60.




Figure 2. Penile exogenous pigmentation: histopathological findings consisting of epithelium hyperplasia, sclerosis and brownish-black
pigment in the superficial chorion, with no evidence of atypical melanocytic proliferation. (A) Hematoxylin and eosin stain original magni-
fication ×17. (B) Hematoxylin and eosin stain original magnification ×32.



2                                                                 Research Letter | Dermatol Pract Concept. 2022;12(1):e2022014
   On the basis of the histopathological findings, a diagnosis      be due to its localization on the mucosa; and as in mela-
of a penile exogenous pigmentation in association with lichen       noma, dermoscopy allows a better recognition of the colors
sclerosus was made.                                                 and the vascular patterns. Moreover, the associated lichen
                                                                    sclerosus may have altered the dermoscopic features of
                                                                    the lesion. Mucosal hyperpigmentation often requires the
Conclusions
                                                                    exclusion of malignant melanoma by performing histo-
Penile melanoma is a rare entity, and therefore, its dermo-         pathological examination, especially when, as in this case,
scopic features have been described rarely. It may show a mul-      the clinical history is not helpful and diagnosis is often
ticomponent pattern, multiple colors (brown, black, white,          not possible on the basis of the clinical and dermoscopic
blue, red), a blue-whitish veil, regression structures, and some    examination alone.
peripheral streaks [1]. The blue, gray, and white colors and           Informed consent: Written informed consent for pub-
the presence of structureless areas are considered strongly         lication of his clinical details and clinical images was
suggestive of mucosal melanoma. Although videodermoscopy            obtained from the patient.
is a useful tool for the early diagnosis of mucosal melanoma
because different colors are more easily detectable in the
                                                                    References
mucosa than in the skin, in this case it did not prove useful for
the diagnosis of a mucosal exogenous pigmentation, which            1. De Giorgi V, Grazzini M, Massi D, et al. Melanoma of the penis: a
                                                                       clinical dermoscopic case study. Acta Derm Venereol. 2010;90(1):
may show the same dermoscopic features.
                                                                       87-88. DOI: 10.2340/00015555-0705. PMID: 20107736.
   The homogeneous pattern shown on dermoscopy of
                                                                    2. Anthony EP, Godbolt A, Tang F, McMeniman EK. Malignant mela-
skin tattoos has been described rarely [2]. The peculiar                noma disguised in a tattoo. Australas J Dermatol. 2015;56(3):232-
dermoscopic appearance of the lesion in our patient may                 233. DOI: 10.1111/ajd.12219. PMID: 26201372.




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022014                                                                          3
