The divided or kissing nevus is an unusual congenital melanocytic nevus. By definition, these nevi appear on skin that separates during embryological development. These lesions have been reported on the eyelids, fingers, and rarely the penis. We describe an 18 year old uncircumcised male who presented with an asymptomatic darkly pigmented patch on the glans penis. He reported that the lesion had appeared recently and was enlarging. Physical examination revealed a second symmetric lesion on the adjacent foreskin. Punch biopsy of the lesion on the glans penis showed abundant intradermal melanocytes devoid of mitoses and atypia, consistent with an intradermal melanocytic nevus. Based on the benign histologic nature and clinical exam, the lesion was diagnosed as a divided or kissing nevus of the penis. Proposed treatments include excision and grafting as well as Nd:YAG laser therapy. However, these patients may be safely monitored with regular follow-up skin examinations because there is minimal risk of malignant transformation.
Persistent nevi are commonly encountered in clinical and dermatopathology practice. Although they may mimic melanoma on clinical presentation as well as microscopic review, they behave in a benign fashion and are not associated with more aggressive behavior than the original nevus. Persistent nevi may exhibit asymmetry and irregular features that prompt concern for melanoma. However, the relative circumscription and restriction of pigment to the surgical scar provides a valuable clue to diagnosis. Some persistent nevi may have a linear pattern when they are confined to a widening scar. In this situation, the pigment spreads along the lines of skin tension (Langer lines). This unique pattern can be easily identified and should be a reassuring finding. We present a case of persistent nevus with a striking perpendicular pigmentation confined to the scar; the clinical and histologic features of persistent nevi are reviewed.
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