Nevus azul vulvar: abordaje quirúrgico y regenerativo.

Vulvar blue nevus is a rare pigmented lesion with an unpredictable clinical course. It is initially associated with melanoma, a malignant pathology of the vulva, and therefore requires differential diagnosis and biopsy to rule out the malignancy. Clinical follow-up is also necessary to monitor associated risk factors, such as prior trauma. In this regard, the surgical and regenerative approach was evaluated in a case of long-standing vulvar blue nevus in a 32-year-old patient. As a child, she sustained trauma from a fall and sexual abuse; a progressively enlarging lesion was observed, occupying the upper third of the right vulvar region. Histological analysis confirmed the clinical diagnosis of “blue nevus of the vulva.” A partial vulvectomy was performed using a 980nm diode laser set at 4 watts with a 600-micron fiber in continuous mode, resulting in an “exquisite” cleavage plane. Platelet-rich plasma (PRP), combined with umbilical cord-derived exosomes, was administered every 15 days to the surgical wound, vaginal introitus, cavernous bodies and clitoris. The excision was successful, showing good healing and improved appearance of the labia majora; there were no signs of malignancy according to the histological study. Emotional trauma-related factors were partially addressed, and the patient’s body image perception improved. It was concluded that surgical management combined with regenerative therapy is effective and safe for the treatment of vulvar blue nevus, helping to mitigate the risk of malignant transformation. The patient expressed a favorable perception regarding the anatomy of her vulva.