Minocycline pigmentation of the vulva masquerading as a melanocytic lesion

CASE REPORT A 67-year-old white woman presented to the dermatology clinic for further assessment of a pigmented vulvar lesion near the urethral meatus that was discovered incidentally 4 months prior. The patient had been examined by 3 gynecologists since discovery of this lesion, which consisted of mostly black pigmentationwith some various shades of grey (Fig 1). A punch biopsy section taken by the second gynecologist showed findings of spongiosis within the epithelium with moderate to numerous superficial melanophages (Fig 2). The differential diagnosis included postinflammatory hyperpigmentation, fixed drug eruption, and irritant contact dermatitis, but a regressed mucosal melanoma was also considered. The third gynecologist started the patient on local estrogen therapy for severe vulvovaginal atrophy and pain, which resulted in a fading of the lesion from a black to grey color along with resolution of the atrophic tissues. The patient did not want to proceed with an additional biopsy at that time, but when the lesion remained unchanged after