Congenital melanocytic nevus of the clitoral hood: A case report

Pigmented lesions of the vulva span a broad spectrum, from benign melanocytic nevi to melanoma. Within this region, the clitoris and clitoral hood are of particular surgical importance because of their sensory and functional roles. Congenital melanocytic nevi (CMN) of the clitoral hood are exceedingly rare, and their optimal management is not well defined. We report a 12-year-old girl with a CMN of the clitoral hood measuring 17 × 13 mm. Because of persistent local pruritus, the difficulty of reliable dermoscopic surveillance at this site, and the family's inability to guarantee periodic follow-up, an elliptical excision with 3-mm margins and immediate reconstruction using local mucocutaneous advancement flaps from the labia minora was performed. Histopathology confirmed a benign compound melanocytic nevus with clear margins. At one-month follow-up the wound had healed with preserved clitoral sensation, no scar contracture or dyschromia, and no functional impairment. This case illustrates that small CMN of the clitoral hood carry a low risk of malignant transformation and that, when excision is chosen for symptomatic or surveillance-related reasons, a conservative plastic-surgical approach can achieve complete removal while preserving genital form and function.