Journal of Pediatric Urology (2010) 6, 318e319

CASE REPORT

Kissing nevus discovered at circumcision consult

Blake Palmer a,*, Michael Hemphill a, Cole Wootton a, J.B. Foshee b,Dominic Frimberger a

a University of Oklahoma, Department of Urology, 920 Stanton L. Young Boulevard, WP 3150, Oklahoma City, OK 73104, USAb University of Oklahoma, Department of Dermatology, 619 Northeast 13th Street, Oklahoma City, OK 73104, USA

Received 22 August 2009; accepted 4 October 2009Available online 31 October 2009

KEYWORDSNevus;Melanosis;Circumcision

* Corresponding author. Tel.: þ1 40E-mail address: blake-palmer@ouh

1477-5131/$36 ª 2009 Journal of Peddoi:10.1016/j.jpurol.2009.10.004

Abstract A divided nevus of the penis is a rare embryological occurrence. The appearance ofa congenital melanocytic nevus can be difficult to distinguish from penile melanosis. Thisarticle presents the successful excision and histopathologic evaluation of one such nevus.ª 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Introduction

A divided or ‘kissing’ nevus was classically defined asa congenital melanocytic nevus that occurs on adjacentparts of the upper and lower eyelids and may appear to bea single lesion when the lids are closed. Cases of dividedmast cell and epidermal nevi of the fingers, as well asdivided nevi of the penis, have also been reported [1].Divided nevi of the penis are extremely rare, with onlyeight cases being reported to date. Here is highlighteda case in which original pathology reports suggested thepossibility of penile melanosis.

Case report

A 6-year-old male presented to clinic for an initial evalua-tion regarding elective circumcision. Physical examination

5 271 6900; fax: þ1 405 271 3118sc.edu (B. Palmer).

iatric Urology Company. Publishe

revealed a 1.5-cm lesion on his right ventral hemiglans. Anopposed lesion on the inner preputial skin was alsodiscovered, located directly across the coronal sulcus uponretraction of the prepuce (Fig. 1).

The lesion showed no malignant properties and thedecision was then made to proceed with elective circum-cision after dermatologic consultation and parentaldiscussion. The preputial skin was sent for histopathologicalevaluation. No biopsy was taken of the lesion on the glansdue to its morphological similarity to the lesion on theprepuce, according to the dermatologist interpretation.

After review of the histopathological findings, the derma-topathologist considered a diagnosis of congenital melano-cytic nevus versus acquired penile melanosis. The family, inconsultation with the dermatology team, elected for biopsyand laser removal of the remaining glanular lesion. Thisresulted in an acceptable cosmetic result. Final pathology ofthepreputial skinwas determined tobean intradermal nevus.

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d by Elsevier Ltd. All rights reserved.

Figure 1 Kissing nevus of the penis. Brown macules on theglans and foreskin on opposing sides of the coronal sulcus.

Kissing nevus discovered at circumcision consult 319

Discussion

Divided nevi occur only on those parts of the body thatseparate at some point during embryogenesis [2]. The samemechanisms believed to result in a divided nevus of theeyelids could explain a divided nevus of the penis. Theseparate lesions may originate from a single lesion in

the embryo that subsequently divides during maturation ofthe external genitalia from the 11th to the 14th week ofgestation [1]. Desruelles et al. proposed that the migrationof melanoblasts precedes the embryological separation ofthe epithelial glanular placode and the epithelial preputialplacode. This developmental sequence consequentlyresults in the clinical presentation of divided nevi, whichmay continue to grow independently after separation [3].

Although biopsy and laser removal of the remainingglanular lesion led to a satisfactory outcome, a moreconservative monitoring approach is appropriate. Penilemelanoma is exceptionally rare, accounting for less than 2%of all primary malignant lesions of the penis. Most arise inthe sixth or seventh decade of life [4]. Furthermore, of theeight reported cases of divided nevi of the penis, only oneunderwent malignant transformation [2]. This information,along with the esthetic challenges presented by lesionremoval, warrants consideration of less invasive care.

Conflict of Interest/Funding

None.

References

[1] Phan PT, Francis N, Madden N, Bunkert CB. Kissing naevus ofthe penis. Clin Exp Dermatol 2004;29:471e2.

[2] Egberts F, Egberts J-H, Schwarz T, Hauschild A. Kissing mela-noma or kissing nevus of the penis? J Urol 2007;69:384.e5e7.

[3] Desruelles F, Lacour JP, Mantoux F, et al. Divided nevus of thepenis: an unusual location. Arch Dermatol 1998;134:879e80.

[4] Demitsu T, Nagato H, Nishimaki K, et al. Melanoma in situ of thepenis. J Am Acad Dermatol 2000;2:386e8.