Genital Lentiginosis on Glans Penis

[youngguy1]

Around five years ago (when I was 18) I noticed a dark spot on my glans just right of my urethra.  The spot at the time, as far as I can remember, was just a little smaller than the diameter of a standard number two pencil eraser, with extremely irreg borders.  I went to my dermatologist and he said it was a freckle, and gave me a topical cream to use and said it may work it may not.  Since this last apt. I would say the “lesion” has probably doubled in size.  Now looks much like this picture, not as extensive tho.
http://www.accessmedicine.com/search/searchAMResultImg.aspx?searchStr=genital+ridge&rootTerm=genital+lentiginosis&searchType=1&rootID=45236
I have never had any pain related to it and no bleeding or anything abnormal, just a dark spot.
I am going back to my dermatologist in 1 week to follow up on my folliculitis for the third time, I wrote you about that as well (Diagnosed with folliculitis , have questions post).
Questions.

-Noting that my “freckle” has spread, is it necessary to biopsy?  What kind of biopsy would he use to be the least destructive?
-Are there alternatives to biopsy to determine if this case of lentiginosis is malignant? (Dermoscopy)?
-This subject is extremely hard to get info online, but I did hear one M.D say benign genital lentiginosis can spread slowly, which is what’s going on in my case.  Does that seem right?
-Is there any form of safe laser removal for this?

Please provide any relevant info on genital lentiginosis; I’m a 23 year old Caucasian male with no known family history of skin cancer.

This post is basically trying to prepare myself incase the Derm says biopsy time; I want to know if that is the only course.

On the folliculitis, would I be out of line asking the Derm to take a culture of the folliculitis to get a definitive answer, I can’t afford to keep going back?

Thanks

Oh ya, I am circumcised (don’t know if that’s relevant)

[Alan Rockoff, MD]

One lentigo (freckle) doesn't equal genital lentiginosis.  The decision whether or not to biopsy can only be made by the doctor doing the exam in person.  Dermoscopy can help but it's not the gold standard.  The only way to know for sure is to do a biopsy, but the doctor may well decide that despite growth the freckle can be left alone and watched.

Yes, culture of folliculitis is a reasonable thing to do, though cultures aren't always revealing.

Best.

Dr. Rockoff

[youngguy1]

Dr. Rockoff
Sorry I don't think that hyperlink worked.  If you need to see the picture (please try) just google genital lentiginosis and it is an Access Medicine site, fifth link down from the top.
Thanks

[youngguy1]

sorry i wasn't descriptive enough (because of limitations of characters).  It is not one freckle, it is multiple and multiplying.

Thanks for the response though.

[youngguy1]

laser treatment?
Yay or Nay