Histopathological findings often reveal increased melanin deposition in the epithelial basal layer and may include melanin-laden macrophages within the connective tissue, without a corresponding rise in the number of melanocytes [9]
Importantly, smokers melanosis does not undergo malignant transformation [11, 36]
13 , 14 Although it is reflected in only a few published studies, we believe that genital melanosis is particularly likely to arise from within an area of lichen sclerosus 13 (Fig
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[7] [8] When to contact your GP: Persistent difficulty achieving or maintaining erections sufficient for sexual activity ED that causes distress or affects your relationship ED accompanied by other symptoms (chest pain, shortness of breath, extreme fatigue) Sudden onset of ED, particularly in younger men When to seek emergency care: Erections lasting longer than 4 hours (priapism) call 999 or go to A&E New severe chest pain during sexual activity call 999 Your GP will conduct a thorough assessment, which typically includes: Medical history exploring cardiovascular risk factors, diabetes, neurological conditions, hormonal issues, and psychological factors Medication review identifying drugs that may contribute to ED Physical examination assessing cardiovascular health, genital examination if indicated Blood tests HbA1c or fasting glucose, fasting lipids, morning (7-11 am) total testosterone with repeat if low/borderline, and consideration of LH/prolactin if hypogonadism is suspected This assessment is crucial because ED can be an early warning sign of cardiovascular disease
