What is your diagnosis for this 22-year-old woman?

 She had also mucosal pigmentations but no pigmentation in other areas....

Diagnosis: Peutz-Jeghers Syndrome 

• Autosomal dominant or sporadic

  STK11 gene (serine-threonine, protein kinase) tumor suppressor gene

  Presents in childhood

  Clinical findings

  Lentigines on mucosa, perorificial skin, palms and digits

  Gasterointestinal hamartomatous polyps (More common in small intestine) may cause bleeding, pain, intussuception, obstruction, adenocarcinoma

  Ovarian cancer  is the most common malignancy

  Breast cancer, pancreatic cancer

  Diagnosis:

  monitor with colonoscopy, polypectomy

  Course:

  normal lifespan malignancy detected early

  Benign gastrointestinal polyps

  Oral and labial melanotic macules: can be associated with LEOPARD syndrome (Lentigines, electrocardiographic conduction defects, ocular hypertelorism, pulmonary stenosis, abnormal genetalia, retardation of growth, and deafness

  Laugier-Hunziker syndrome: absence of intestinal polyps

  Histology:

  mild acanthosis and hyperpigmentation of basal layer

  Treatment:

  cryosuergery (melanocytes freeze at -4 to -7 degree centigrade, laser, tretinoin, chemical pee)

  ---

  Comment by; Dr. Mehrdad Mehravaran, Szeged, Hungary: