Melanocytic nevi in the genital area: dermoscopic clues to diagnosis

Benign melanocytic nevi on genital mucosal or semimucosal sites may show clinical and dermoscopic atypia, often leading to biopsy. We retrospectively reviewed histologically confirmed genital melanocytic nevi diagnosed at the University of Florence (Italy) between January 2005 and December 2022 in patients aged ≥14 years. Forty-three patients were included (14 males, 29 females; median age 34 years). Lesions were more common on vulvar than penile sites, especially the labia minora and glans. Two predominant global dermoscopic patterns were present in 40 lesions (93%): a comet pattern in 25 (58%), characterized by a darker, densely structured "head" (most commonly linear pigmentation and/or globules, sometimes with a blue hue) and a less pigmented "tail", and a globular pattern in 15 (35%), characterized by large, well-defined blue-to-black clods/globules with uniform pigmentation; 3 lesions (7%) had a nonspecific pattern. Recognition of these benign patterns, together with attention to melanoma-associated mucosal clues, may support more confident assessment and management of genital pigmented lesions.