Vulvar pigment spots

　　First, Etiology

　　Vulvar pigment spots are caused by excessive growth of pigment cells. Nevus cells originate from two types of cells, namely the pigment cells within the epidermis and the Schwann cells of the cutaneous nerves. Junctional nevi mainly originate from pigment cells. Melanocytic nevi originate from epidermal pigment cells and dermal nerve sheath cells. Nevi can grow on various parts of the body, and nevi growing on the vulva may be prone to malignant transformation due to their location on a stimulated area.

　　Second, Pathogenesis

　　Pathologically, pigment spots are divided into 3 types, namely junctional nevi, intradermal nevi, and combined nevi. Intradermal nevi are completely located in the dermis and are less common. Junctional nevi refer to nevus cells located at the junction of the epidermis and dermis, and early nevi or childhood nevi are mostly junctional nevi. When part or most of the junctional nevus extends into the dermis, it is called a combined nevus. The cells of combined nevi are round or cuboidal, with clear cell membranes, uniform cytoplasm, containing melanin, large nuclei, and light staining.

　　Pigment spots are very sensitive to steroid (steroidal) hormones. Pigment spots are often not prominent in childhood, but gradually deepen and increase in size after puberty. Some people advocate for prophylactic removal of pigment spots in pregnant women, while Allen et al. believe that pregnancy has no relationship with the malignant transformation of pigment spots, and there is still a lack of clear evidence in this regard.

　　1, Pathological characteristics of moles

　　Macroscopically, moles appear black, with a flat or raised surface, even papillary, and may have hair on the surface. Flat moles are often junctional nevi. Under the microscope, mole cells appear black, with oval or semicircular cells, clear cell membranes, and black-brown granules in the cytoplasm. The nucleus is unclear. Mole cells in the deep dermis often appear spindle-shaped, with no pigment in the cytoplasm, indicating that the mole cells are aging.

　　Moles are divided into 5 types:

　　(1) Flat nevus: mostly junctional type.

　　(2) Elevated nevus: mostly compound nevus.

　　(3) Papillomatous nevus: most are intradermal type, but can also be compound type.

　　(4) dome nevus: often intradermal type.

　　(5) Pedunculated nevus: intradermal type.

　　2. Pathological characteristics of blue nevi

　　(1) Macroscopically: slightly raised, clear boundary, blue small nodules with a diameter of 0.2-0.5 cm, the largest not exceeding 1.5 cm.

　　(2) Under the microscope: located in the dermis, mole cells are spindle-shaped pigment cells with processes extending out, arranged in bundles parallel to the epidermal surface. Sometimes the cells extend into the subcutaneous fat tissue. When there are many cells, they are called rich cell blue nevi.

　　Stimulation or friction can cause the spread of local inflammation and the development of vulvitis and vaginitis. Vaginitis is the inflammation of the vaginal mucosa and submucosal connective tissue, a common disease in gynecological clinics. Normal healthy women, due to anatomical and biochemical characteristics, have a natural defense function against pathogen invasion. When the natural defense function of the vagina is destroyed, such as infection of vulvar soft fibroma, pathogens are more likely to invade, leading to vaginal inflammation. Young girls and postmenopausal women, due to the lack of estrogen, have thin vaginal epithelium and reduced intracellular glycogen content, with a vaginal pH of about 7, so the vaginal resistance is low, making them more susceptible to infection than prepubertal and childbearing women.

　　During gynecological examination, the color of moles can range from light brown to black, and they can be flat or raised, generally small.

　　1. Moles

　　The common sites are the labia majora and minora, which are often black, with a flat and raised papillary surface. Clinically, there are no specific symptoms. Long-term irritation or friction may cause local pain, itching, bleeding, or inflammatory reactions. During gynecological examination, brown, light brown, or blue-black macules may be seen on the labia majora, slightly raised or flat, with some long hair. Lesions are generally small, solitary, and common. Moles are sensitive to sex hormones and often increase in size and become darker during puberty. If the mole's color suddenly deepens, the area becomes shallow or radiates, the area increases, the surrounding skin becomes red, ulcers and bleeding occur, and the patient experiences itching, one should be vigilant about the possibility of malignant transformation into malignant melanoma. Malignant melanoma originating from mole cells often occurs at a younger age, grows rapidly, has a high degree of malignancy, and is prone to early metastasis. Therefore, the correct diagnosis of vulvar melanocytic nevus is of special significance for the early prevention and treatment of melanoma, especially for young women. The distinction between the two should be paid special attention to.

　　2, Blue Nevus:

　　They are 0.2 to 0.5 cm in diameter, slightly elevated, clear boundary, blue-black small nodules, mostly asymptomatic.

　　Holland (1949) reported that although the skin of the vulva accounts for only 1% of the total epidermis of the body, 7% to 10% of female malignant melanomas occur in the vulva, with a high mortality rate. Since vulvar moles may develop into malignant melanoma, preventing their occurrence and canceration is crucial. Early diagnosis, active treatment, and follow-up work should be done. There is a possibility of malignant transformation.

　　The following examinations can be performed to exclude other diseases:

　　One, Routine Examination of Vaginal Secretions:

　　Vaginal secretions are the fluids secreted by the female reproductive system, also known as leukorrhea. Observing the color and characteristics of vaginal secretions can clarify the lesions of the vulva or vagina.

　　Two, Tumor Marker Examination:

　　Tumor markers (Tumor Marker) are chemical substances that reflect the presence of tumors.

　　1, Produced by the tumor tissue, including: differentiation antigens; embryonic antigens (AFP, CEA); isoenzymes (NSE); hormones (HCG); tissue-specific antigens (PSA, freePSA): mucins, glycoproteins, glycolipids (CA125); oncogenes and their products; polyamines, etc.

　　2, Produced after the interaction between the tumor and the host, including: serum ferritin; immune complexes; acute phase proteins; isoenzymes; interleukin receptors; tumor necrosis factors, etc.

　　Three, Tissue Pathological Examination:

　　1, Melanocytic Nevus:

　　(1) Grossly: black nevus, surface flat or elevated, even乳头状, with hair on the surface. Flat nevi are often junctional nevi.

　　(2) Under the microscope: nevus cells are black, oval, semicircular, with clear cell membranes, black-brown granules in the cytoplasm, unclear nuclei. The nevus cells in the deep dermis are often fusiform, without pigment in the cytoplasm, indicating the aging of nevus cells.

　　2, Blue Nevus:

　　(1) Grossly: slightly elevated, clear boundary, blue nodules with a diameter of 0.2 to 0.5 cm, the largest not exceeding 1.5 cm.

　　(2) Under the microscope: located in the dermis, the nevus cells are fusiform pigmented cells with processes extending out, arranged in bundles parallel to the epidermal surface. Sometimes the cells extend into the subcutaneous fat tissue. When there are many cells, it is called a rich cell blue nevus.

　　One, Dietary Treatment for Vulvar Pigmented Lesions

　　1, Ginseng Porridge: 3g of ginseng powder (or 15g of codonopsis), appropriate amount of rock sugar, 100g of good rice, cooked as a regular meal.

　　2, Astragalus Porridge: 50g of Astragalus membranaceus, boiled to extract the juice for making porridge, 100g of good rice, appropriate amount of brown sugar, and 3g of skin powder, all cooked together to make porridge.

　　3, Astragalus Chicken with Angelica Root: 20g of Angelica sinensis, 100g of Astragalus membranaceus, and 1 hen, all steamed together and taken in doses.

　　4, Ginseng and Jujube Rice: 3g of ginseng (or 15g of codonopsis), 20g of jujube, 250g of good rice, and 50g of sugar. The ginseng and jujube are chopped and steamed together, and the rice is cooked. Add sugar and take it in doses.

　　5. 30g of Atractylodes macrocephala, 250g of jujube, chicken sand, dried ginger, flour, oil, salt and other spices in appropriate amounts. All the drugs are ground into powder or cut into very fine pieces, mixed with flour and spices, fried into cakes, and eaten in several doses.

　　Second, what to eat for vulvar pigmented nevus is good for the body

　　Eat more alkaline substances to prevent cancer.

　　1. Weakly alkaline foods: red beans, radishes, apples, kale, onions, tofu, etc.

　　2. Moderately alkaline foods: dried radish, soybeans, carrots, tomatoes, bananas, oranges, melons, strawberries, protein, dried plums, spinach, etc.

　　3. Strongly alkaline foods: turnips, grapes, tea, kelp sprout, kelp, etc.

　　Third, it is best not to eat the following foods for vulvar pigmented nevus

　　1. Abstain from food that causes itching and inflammation. Such as fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., after eating, it will aggravate the itching and inflammation of the vulva.

　　2. Try to eat less spicy and stimulating foods. For example: onions, pepper, chili, Sichuan pepper, mustard, fennel.

　　3. Avoid eating fried and greasy foods. Such as oil sticks, butter, butter, chocolate, etc., these foods have the effect of promoting dampness and increasing heat, which will increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

　　4. Quit smoking and drinking.

　　Due to the potential for malignant transformation of black moles on the vulva, they should be excised in a timely manner, especially for flat junction nevi with a high tendency for malignant transformation. The excision range should be 1-2 cm outside the lesion, and the depth should reach normal tissue. And it should be excised together with the subcutaneous tissue.

　　The indications for the excision of black moles on the vulva in pregnant women are: when the mole is stimulated, when the mole is smooth, the color deepens, or grows, or when combined with ulceration, bleeding, or pain, it should be excised. In addition, any of the following points indicates the possibility of malignant transformation, and immediate medical treatment should be sought, with a larger area of excision.

　　1. The pigmented nevus is significantly or rapidly enlarged.

　　2. The color deepens and becomes shiny.

　　3. The surface often has bleeding or scab formation.

　　4. The pigmented nevus has an ulcer.

　　5. Satellite black moles appear around the pigmented nevus.

　　6. The pigmented nevus forms a hard nodule.

　　Black moles that are obviously higher than the skin surface and have hair are rarely malignant unless stimulated, bleeding, or painful, and there is no need to rush to deal with them.

　　The incidence of malignant transformation of blue nevus is generally low, advocating surgical treatment, and sending frozen sections during the operation.