Ringlike pattern as a dermatoscopy sign for vulvar melanosis does not preclude synchronous existence of vulvar melanoma.

Vulvar melanoma (VM) accounts for 1-3% of all melanoma arising in women with poor long-term clinical outcome.[[1]] VM can be uni- or multifocal.[[3]] Multifocality is defined as multiple foci of melanoma separated by intact epithelium, or arising on follow-up, outside the vicinity of the surgical scar.[6] Total of 66% of the patients had more than one focus of melanoma, either apparent at their initial diagnosis or developed during follow-up.[6] There were only 25 cases of dermatoscopy of VM published so far, where blue, grey or white colour plus structureless zones, multicomponent patterns with irregular dots/globules, blue-white veil and atypical vessels were highly predictive for melanoma.[[1], [3], [7]] Ringlike pattern is considered to be the frequent finding and the clue for vulvar melanosis, the most common clinical impersonator of VM,[[1], [3], [7]] reassuring feature suggestive of benign process,[7] not associated with melanoma and naevi.[3] No dermatoscopy of recurrent VM has been published, to date. Biopsies revealed melanoma, Breslow 2.25 mm, diagnosed in a small nodule on the left side of the vulva (Fig. b). [Extracted from the article]