Vulvar lesions: Diagnostic evaluation
- Lynette J Margesson, MD, FRCPC, FAAD
Lynette J Margesson, MD, FRCPC, FAAD
- Assistant Professor of Surgery (Section of Dermatology) and Obstetrics and Gynecology
- Geisel School of Medicine at Dartmouth
- Hope K Haefner, MD
Hope K Haefner, MD
- Department of Obstetrics and Gynecology
- The University of Michigan Health System
- Section Editor
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
A wide spectrum of benign, premalignant, and malignant lesions may occur on the vulva. The challenge to the clinician is to differentiate between normal variants, benign findings, and potentially serious diseases.
This topic will discuss the diagnostic evaluation of women with vulvar lesions. The differential diagnosis of vulvar lesions is reviewed separately. (See "Vulvar lesions: Differential diagnosis based on morphology".)
Ideally, the history is obtained before the patient undresses for her physical examination. In addition to a standard medical history, answers to the following questions can help identify possible causes of the vulvar lesion and exclude others. The answers to these questions may suggest a systemic disease rather than a primary localized vulvar disorder. The answers may also increase the clinician’s suspicion of dermatitis or infection as the etiology of the lesion.
●How long has the lesion been present? Was the onset sudden or gradual? Could it be related to trauma or another trigger?
●How did the lesion look when it first appeared? Is it different now? Does it come and go?To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Rodolakis A, Diakomanolis E, Vlachos G, et al. Vulvar intraepithelial neoplasia (VIN)--diagnostic and therapeutic challenges. Eur J Gynaecol Oncol 2003; 24:317.
- Darragh TM, Colgan TJ, Cox JT, et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis 2012; 16:205.
- Bornstein J, Bogliatto F, Haefner HK, et al. The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions. J Low Genit Tract Dis 2016; 20:11.
- Bae-Jump VL, Bauer M, Van Le L. Cytological evaluation correlates poorly with histological diagnosis of vulvar neoplasias. J Low Genit Tract Dis 2007; 11:8.
- Eidelman A, Weiss JM, Lau J, Carr DB. Topical anesthetics for dermal instrumentation: a systematic review of randomized, controlled trials. Ann Emerg Med 2005; 46:343.
- Juhlin L, Evers H. EMLA: a new topical anesthetic. Adv Dermatol 1990; 5:75.
- ACOG Practice Bulletin No. 93: diagnosis and management of vulvar skin disorders. Obstet Gynecol 2008; 111:1243.
- Chang SD. Imaging of the vagina and vulva. Radiol Clin North Am 2002; 40:637.