Vulval Moles: Identifying Melanocytic Naevi and When to See a UK Doctor

A vulval melanocytic naevus is the clinical term for a mole located on the vulva (the external part of the female genitals). Just like moles on your arms or back, these are clusters of pigmented cells called melanocytes. While most women are familiar with monitoring moles on their limbs, finding a dark spot in the genital area can often cause significant anxiety.

In the UK, it is estimated that around 2% to 5% of women have melanocytic naevi in the vulval region. These moles can be present from birth (congenital) or develop during childhood and adulthood. While the majority of these spots are entirely benign (non-cancerous), the vulva is a sensitive area where skin changes can sometimes be overlooked during routine self-examinations.

Not every dark mark on the vulva is a mole. It is important to distinguish between different types of pigmentation:

• Vulval Melanocytic Naevi: These are typical moles. they can be flat or slightly raised, usually brown or black, and have well-defined borders.
• Vulval Lentigo: Also known as a 'freckle', these are flat, dark spots caused by an increase in melanin rather than a cluster of melanocytes. They are very common and harmless.
• Vulval Melanosis: This presents as larger, irregular flat patches of pigment. While they can look concerning due to their shape, they are generally benign.
• Post-inflammatory Hyperpigmentation: Darker patches that appear after the skin has healed from conditions like eczema, psoriasis, or lichen sclerosus.

Because these conditions can look similar to the naked eye, a clinical assessment—often involving a dermatoscope (a specialised magnifying tool)—is necessary for an accurate diagnosis.

NHS guidance suggests that women should regularly check their vulval area for any changes. When inspecting a mole, you should apply the same ABCDE criteria used for general skin cancer screening:

• Asymmetry: Does one half of the mole look different from the other half?
• Border: Are the edges blurred, jagged, or irregular?
• Colour: Is the mole a mix of different shades (brown, black, red, or white) rather than one solid colour?
• Diameter: Is the mole larger than 6mm (about the size of a pencil eraser)?
• Evolving: Is the mole changing in size, shape, or thickness, or has it started to itch or bleed?

If you notice any of these features, you should arrange to speak to a GP. While vulval melanoma is rare—accounting for less than 5% of all vulval cancers—early detection is critical for successful treatment.

Many women feel embarrassed about seeking help for genital skin changes, which can lead to delays in diagnosis. An online doctor in the UK offers a private, calm, and professional environment to discuss your concerns without the wait times often associated with local surgeries.

You should consider a GP consultation if:

• You have discovered a new dark spot that wasn't there previously.
• An existing mole has changed in colour or become raised.
• A pigmented area is causing symptoms like persistent itching, soreness, or bleeding.
• You have a personal or family history of atypical moles or melanoma.

During a video consultation, a GP can discuss your symptoms, take a history, and advise on whether an urgent in-person physical examination or a referral to a dermatologist is required under NICE (National Institute for Health and Care Excellence) guidelines.

If a GP is concerned about a vulval mole, the standard UK pathway involves a referral to a specialist, usually a dermatologist or a gynaecologist with an interest in vulval disease. The specialist may use a dermatoscope to look at the pigment patterns in detail.

If the lesion looks suspicious, a skin biopsy may be performed. This involves removing a small piece of the mole (or the entire mole) under local anaesthetic so it can be examined under a microscope. If the mole is confirmed to be a benign melanocytic naevus, no further treatment is usually needed. If it is found to be atypical (dysplastic) or cancerous, further surgery may be required to ensure a clear margin of healthy tissue is removed.

General vulval care can help you stay aware of changes and reduce irritation. The NHS recommends avoiding scented soaps, bubble baths, or vaginal deodorants, as these can cause inflammation that might mask or mimic skin changes. Using a simple emollient as a soap substitute is often recommended. Routine self-checks using a mirror once a month can help you become familiar with what is 'normal' for your body, making it easier to spot a new vulval melanocytic naevus or change early on.