NOTE
Vulvar dystrophies must also be considered in patients presenting with vulvar itching.Malignant vulvar lesions
Vulvar carcinoma is an uncommon gynecologic malignancy, with mean age at
diagnosis age 65. It is the fourth most common gynecologic malignancy. Risk
factors include older age, cigarette smoking, HIV, and premalignant vulvar
dermatosis.
Squamous hyperplasia. These lesions appear as whitish focal or diffuse
areas that are firm and cartilaginous on palpation. Histologically, they show
thickened keratin and epithelial proliferation. Management is fluorinated
corticosteroid cream.
Lichen sclerosus. This appears as bluish-white papula that can coalesce into
white plaques. On palpation they feel thin and parchment-like. Histologically,
they show epithelial thinning. Management is clobetasol cream.
Squamous dysplasia. These lesions appear as white, red, or pigmented and
are often multifocal in location. Histologically, they show cellular atypia
restricted to the epithelium without breaking through the basement membrane.
The appearance is almost identical to cervical dysplasia. Management is
surgical excision.
CIS. The appearance is indistinguishable from vulvar dysplasia.
Histologically, the cellular atypia is full thickness but does not penetrate the
basement membrane. Management is laser vaporization and vulvar wide
local excision.