Black Lesions in the Perineum: When to Seek Help

Melanoma in the perineal region?

Hello Doctor, I would like to ask about a situation I experienced.
When I was a child, I accidentally pinched my perineum while playing on a seesaw.
Since there was no visible wound, I didn't pay much attention to it.
However, over time, a black lump approximately one centimeter in diameter has developed in that area.
It feels like normal skin when touched, but it is painful when pressed hard.
This has been present for over a decade without any growth or other abnormalities.
I would like to inquire about the following: 1.
Is there a health concern that requires a medical consultation, or can I ignore it? 2.
If a consultation is necessary, should I see a dermatologist or a urologist? 3.
If I wish to have it removed, will it be covered by health insurance? Thank you, Doctor.

Wang, 20~29 year old female. Ask Date: 2017/03/29

Dr. Wu Yuxin reply Dermatology

1.
It is impossible to determine without actually seeing the lesion; if it is very concerning, please seek medical attention as soon as possible.
2.
Urology.
3.
A definitive diagnosis can only be made after examination.

Reply Date: 2017/03/29

More Info

When it comes to black lesions in the perineum, especially those that have been present for an extended period, it is essential to approach the situation with caution. Based on your description, you have a black lesion that has been stable for many years, which is a positive sign. However, there are several factors to consider regarding your health and the potential need for medical evaluation.

1. Health Concerns: While the lesion has not changed in size or appearance over the years, any persistent skin lesion, especially one that is pigmented, warrants a professional evaluation. There is a possibility that it could be a benign condition, such as a dermatofibroma or a seborrheic keratosis, but it could also be something more serious, such as a melanoma or other skin cancer. Given that it has been painful when pressed, this could indicate irritation or other underlying issues that should not be ignored. It is always better to err on the side of caution when it comes to skin lesions, especially those that are pigmented.

2. Which Specialist to See: For your situation, it would be most appropriate to consult a dermatologist. Dermatologists specialize in skin conditions and are trained to evaluate and manage various skin lesions. They can perform a thorough examination and may recommend a biopsy if there is any suspicion of malignancy. A urologist, while knowledgeable about the urinary and reproductive systems, may not have the same level of expertise in skin lesions as a dermatologist.

3. Insurance Coverage for Removal: Regarding the potential removal of the lesion, whether or not your health insurance will cover the procedure depends on several factors, including the reason for the removal. If the lesion is deemed medically necessary to remove (for example, if it is suspected to be cancerous or causing significant discomfort), it is more likely to be covered. However, if it is considered purely cosmetic, coverage may not be provided. It is advisable to discuss this with your dermatologist, who can provide documentation and justification for the procedure if needed.

In summary, while your lesion has remained stable for many years, it is crucial to have it evaluated by a dermatologist to rule out any serious conditions. They can provide you with a definitive diagnosis and discuss potential treatment options, including removal if necessary. It is always better to be proactive about skin health, especially with lesions that have been present for a long time. Seeking medical advice will give you peace of mind and ensure that you are taking the right steps for your health.

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