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Acta Obstétrica e Ginecológica Portuguesa

versión impresa ISSN 1646-5830

Acta Obstet Ginecol Port vol.13 no.4 Coimbra dic. 2019



Actinic dark pigmentation of the vagina mimicking melanoma

Pigmentação escura actínica da vagina imitando melanoma

Bárbara Bizzo Castelo1, José Alberto Fonseca Moutinho2, Ramona Carvalho Barros3

Centro Hospitalar Universitário Cova da Beira - Covilhã, Portugal

1 Medical Student, Universidade Federal de Juiz de Fora Faculdade de Medicina, Brasil

2 Director do Serviço de Obstetrícia e Ginecologia Centro Hospitalar Cova da Beira

3 Medical Studente, Universidade do Estado do Pará, Brasil

Endereço para correspondência | Dirección para correspondencia | Correspondence



A puerperal vulvovaginal hematoma is not an unusual finding after vaginal deliveries. However, most of them are small and self-limited. Even though there are multiple risk factors identified, the majority of cases happen in low risk settings. We here report a case of a nulliparous young woman who developed a massive pararretal hematoma after an uncomplicated vaginal delivery. Surgical intervention was useful but selective embolization was required. Our goal is to highlight the importance of being aware of this potential complication of a vaginal delivery and the need of an early diagnosis in order to offer the most suitable treatment and prevent severe damages.

Keywords: Hematoma; Postpartum period; Therapeutic embolization.


A 58 year-old woman had her first appointment at our department complaining about vaginal dryness and dyspareunia. She reported a total hysterectomy at age 42 due to uterine fibromyoma and also a rectal cancer at age 56 treated with chemo-radiotherapy. There were no other symptoms and the patient was not using any medication. During her gynaecological examination, a painless flat dark and soft lesion with a maximum diameter of 2 cm was found, located at the middle 1/3 of the posterior wall of the vagina (Fig.1). On the other hand, the vaginal vault had no macroscopic lesions, the bimanual examination was pain free and no other abnormality was registered. At digital rectal examination, no rectal tumours were found and the posterior wall of the vagina was easily and painlessly depressed and not thickened. A diagnosis of vaginal melanoma was considered and a biopsy was taken, after a local Xylocaine anesthesia. The choice of performing a biopsy over a lesion excision was determined by its size and the difference between treatments in case of malignancy or not. Histology (fig.2) revealed dermic deposits of melanin, suggesting actinic etiology, and a light melatonin deposition at basal cells of squamous epithelium, compatible with associated melanosis. Vaginal actinic melanocytic pigmentation and melanosis stands as the final diagnosis, presumably related to the previous exposure to radiotherapy for rectal carcinoma treatment, since it was the only traumatic event identified in the patient’s history. The patient was conservatively followed and no progression of the lesion was reported in the last 2 years of regular follow-up.




Vaginal actinic lesions after radiotherapy are uncommon1 and the doctor needs to be enabled to differentiate it from others pigmented skin lesions in the genital area, such as nevi, melanoma, angiokeratomas, seborrheic keratosis, squamous cell carcinoma, basal cell carcinoma2. In our literature research, we only found one case report of melanosis of the vagina that also mimics vaginal melanoma3, as in our case. In conclusion, as actinic lesions are rare, all the pigmented lesions of the vagina must be biopsied in order to exclude malignancy.



1. Padilha CML, Bergamann A, Chaves CBP, Thuler LCS, Araújo Júnior MLC, Souza SAL. Efeitos celulares actínicos pós-radioterapia por câncer de colo uterino. IJC Radio 2017

2. Cengiz, FP; Emiroglu, N; Wellenhof, RH. Dermoscopic and Clinical Features of Pigmented Skin Lesions of the Genital Area. An. Bras. Dermatol., Rio de Janeiro, v. 90, n. 2, p. 178-183, Apr. 2015.

3. Karney MY, Cassidy MS, Zahn CM, Snyder RR. Melanosis of the vagina. A case report. J Reprod Med. 2001 Apr;46(4):389-91


Endereço para correspondência | Dirección para correspondencia | Correspondence

Bárbara Castelo

Universidade Federal de Juiz de Fora Faculdade de Medicina

Juiz de Fora, Brasil



Recebido em: 10/03/2019

Aceite para publicação: 10/06/2019

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