When Age and Morphology Mislead: Flat Vulvar Melanoma In Situ in a Young Woman

Abstract

Pigmented vulvar lesions are frequently encountered in clinical practice and are most often benign, particularly in young women presenting with flat lesions. In contrast, vulvar melanoma predominantly affects postmenopausal patients and is typically associated with raised or palpable morphology, features that usually prompt diagnostic investigation. We report the case of a 28‐year‐old woman presenting with an asymptomatic, flat pigmented lesion of the labia majora that appeared clinically low risk. Dermoscopic examination revealed asymmetric multicomponent pigmentation with blue–white veil and irregular dots and globules, supporting the decision to perform an excisional biopsy in the context of clinic–dermoscopic correlation. Histopathological findings confirmed melanoma in situ. This case illustrates a clinically important variation from the expected presentation of vulvar melanoma and highlights the potential risk of relying solely on reassuring demographic features. Careful clinical assessment and dermoscopic evaluation remain essential in the assessment of vulvar pigmented lesions, even in young patients with flat, apparently benign‐appearing lesions.