Vulvar Lesions

Abstract

A woman presents with persistent vulvar lesion(s). She denies pain (hence vulvodynia is excluded). The differential diagnosis varies whether the lesions are papular or patch/plaque.

Papular lesions may be condyloma, Bowenoid Papulosis , multiple syringoma, or multiple cysts. Patch lesions may represent lichen sclerosis, lichen planus, and vulvovaginitis while plaque lesions may represent lichen simplex chronicus, squamous cell carcinoma in situ, and extramammary Paget disease.

The female genital region has significant normal histological variation based on the site being examined. The labia majora are an extension of the adjacent skin and histologically similar. The labia minora is modified mucosa just as the dry mucosa or the vermilion border of the lip. The vaginal introitus and the lining of the vagina is mucosa just like the wet mucosa of the lip and buccal mucosa. Hence, what is normal for one site may be abnormal for another. When performing a biopsy of female genitalia, an indication of the specific site on the requisition form is essential.