Penile Melanosis

While treatment is generally unnecessary for penile melanosis, available choices for those who want intervention include surgical excision or laser therapy.

Penile melanosis is typically a benign condition marked by small areas of darker skin on the penis. This discoloration is a form of hyperpigmentation, occurring when melanin (the brown pigment) accumulates in the epidermal layer.

Also referred to as penile lentiginosis, the darker patches or lesions may appear on the glans or along the shaft. The disorder is usually harmless and does not require medical treatment. It is not contagious.

What are the symptoms of penile melanosis?

Aside from the darker macules, penile melanosis does not cause systemic or physical symptoms. The primary features are macules that are:

• most often brown or black
• smaller than one centimeter
• reported in people aged 15 to 72, although they can develop at any stage of life
• painless and unlikely to bleed or transform over time

A person may have a solitary dark spot or multiple macules; there is no reliable way to predict how many lesions will be present.

In uncommon situations, penile melanosis is associated with lichen sclerosus, a disorder that causes thinning of penile skin and white patches on the glans or foreskin.

Topical therapies can sometimes manage lichen sclerosus, a condition thought to involve hormonal imbalance or an abnormal immune response.

However, topical steroids and similar medications do not change the pigmentation seen in penile melanosis. Lichen sclerosus more commonly affects the foreskin of uncircumcised men, and circumcision is occasionally required as treatment.

What causes penile melanosis and who is at risk?

The exact reason why some people develop penile melanosis while others do not is unclear. The lesions represent localized accumulations of melanin or other pigmentary substances such as hemosiderin and lipofuscin within the skin.

One study suggests that ethnicity and genetic factors may influence the likelihood of developing the condition.

Other possible contributors include trauma to the penis, use of the psoriasis medication anthralin, or psoralen combined with ultraviolet light (PUVA) therapy, which is employed to treat psoriasis, eczema, and related dermatoses.

Penile melanosis is not a sexually transmitted disease — in fact, it does not reflect any infectious process.

What treatments are available for penile melanosis?

In most cases, no medical intervention is needed or advised for penile melanosis. Many people find reassurance from their clinician about its benign nature is sufficient. It’s important to know the condition is noncancerous and not contagious.

Removal options

If the appearance of macules is bothersome, surgical excision of the lesions may be an option. This operation removes the pigmented skin layer and typically involves a skin graft and resurfacing to achieve an acceptable texture and thickness.

Laser therapy is another possibility. The indicated device is a Q-switched ruby laser, which uses a synthetic ruby and delivers brief, intense pulses of laser energy.

This approach is commonly used for pigment-related skin issues. Multiple sessions may be required to clear the lesions fully.

These procedures can leave minor scarring but are generally safe and do not compromise penile health or function. Discuss potential risks and benefits thoroughly with your clinician before proceeding.

Can penile melanosis be prevented?

There is no known way to prevent penile melanosis; it occurs unpredictably. Your doctor may keep periodic photographs of the macules to monitor any alterations in size or shape. Although uncommon, changes could indicate melanoma, a serious form of skin cancer.

Are there complications?

No physical complications are linked to penile melanosis. The condition can, however, cause psychological distress, worry, or embarrassment. If these feelings become overwhelming, speak in detail with your doctor about concerns and possible management strategies.

What is the prognosis?

Because penile melanosis is benign, the prognosis is excellent. There is no strong evidence that penile melanosis progresses to melanoma, though the spots can understandably provoke anxiety.

Learning about penile melanosis and discussing it with a dermatologist usually helps reduce worry about this harmless condition.