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Definition / general Penile melanosis and penile lentiginosis are benign pigmented lesions frequently found in glans and foreskin Penile melanosis shares clinicopathological features with Laugier-Hunziker syndrome of oral mucosa (eMedicine: Laugier-Hunziker Syndrome [Accessed 30 March 2018]) and vulvovaginal melanosis (J Am Acad Dermatol 1989;20:567) Clinical features Benign, although associated with melanoma Penile melanosis: Large, often single, flat and pigmented macule with irregular borders Pigmentation may be associated with Laugier-Hunziker syndrome (Int J Dermatol 2004;43:571) Penile lentiginosis: Penile lentigines are 0.2 - 2 cm, oval to irregular lesions with uniform or variegated pigmentation Areas of depigmentation are characteristic Lesions are scattered on shaft or glans Clinically may resemble an atypical melanocytic lesion May be associated with Cowden disease (J Cutan Med Surg 2001;5:228), Bannayan-Riley-Ruvalcaba syndrome (J Am Acad Dermatol 2005;53:639) Microscopic (histologic) description Penile melanosis: Melanocytic hyperplasia, hyperpigmentation of basal epithelium and otherwise normal epithelium Penile lentiginosis: Elongation of rete ridges with basal layer hyperpigmentation, slight melanocytic hyperplasia, epithelial hyperplasia and stromal melanophages, no atypia (J Am Acad Dermatol 1990;22:453) In hyperpigmented areas, there are increased number of melanocytes along the basal layer Lymphocytes, which are found in close apposition, destroy melanocytes and surrounding keratinocytes lack pigmentation (Pigment Cell Res 1992;5:404) Differential diagnosis Congenital melanocytic nevus Melanoma: difficult to distinguish clinically, may need to biopsy (Urology 1976;7:323)