Exam 2 Vulvar Dz

Question 1

Lichen Sclerosus is?

Answer 1

Vulvar disorder:
Benign, chronic inflamm

Autoimm attacks all levels of skin

Question 2

Lichen Sclerosus risk factors? (6)

Answer 2

FHx
Incontinence
Infection
Contact derm
Trauma
Hormones

Question 3

Lichen Sclerosus presentation? (4)

Answer 3

U postmeno
ITCHING
Dysuria
Dyspareunia

Question 4

Lichen Sclerosus exam findings? (4)

Answer 4

Sharp/well demarcated white plaques w/
cigarette paper, waxy or hyperkeratotic appearance

Hallmark: Fragility (purpura, erosion, fissure)

U starts periclitorally -> perineal skin

U NOT in keratinized/hairy labia majora or muc mem (vag, vestibule, rectal muc)

Question 5

Lichen Sclerosus studies?

Tx?

Answer 5

Vulvar punch bx

Topical steroid OINTMENT (Clobetasol)
Hygiene
Long term f/u (chronic dz)

Question 6

Lichen Sclerosus (P) risks?

Answer 6

SCC if tx neglected

Pigment ∆s take seriously

Question 7

Bartholin Cyst is?

Answer 7

Vulvar disorder:

Bartholin mucus gland obstruction from trauma/inflamm

Question 8

Bartholin Cyst presentation? (3)

Answer 8

Acute, painful, unilateral labial swelling
Dyspareunia
Pain w/ sit/walk

Question 9

Bartholin Cyst exam findings? (5)

Answer 9

Tender, fluctuant mass
Erythema/Edema
Cellulitis
Abscess
Fever

Question 10

Bartholin Cyst tx? (4)

Answer 10

I&D w/ Word catheter
ABx if cellulitis: Bactrim or Clinda if allergic
Sitz bath
No sex till catheter out

Question 11

Vulvar Intraepithelial Neoplasm (VIN) is?

Answer 11

Neoplastic cells w/i squamous epith

Question 12

VINu (usual) a/w?

Risk factors?

Answer 12

HPV 16/18
U younger

Smoking!
Immunosup
Sluts

Question 13

VINu presentations?

Answer 13

C asympt

Vulvar burn/itch

Question 14

VINu studies? (2)

Answer 14

C a/w Cervical IN -> colposcopy MANDATORY

Bx all pigmented lesions

Question 15

Colposcopy is?

Answer 15

Acetic acid on vulva ->
Accentuates white and vascular lesions ->
Bx multiple sites (raise or flat, any color)

Question 16

VINu tx:

CA suspected?

CA not suspected?

Answer 16

Wide local excision if CA suspected

No suspicion for CA then ->
CO2 laser full thickness of epith
Imiquimod (Aldara)

High recurrence

Question 17

VINd (differentiated) is from?

Answer 17

NOT HPV related

a/w squamous cell hyperplasia (lichen sclerosus, lichen simplex)

Carcinogenic agent + chronic irritation causes dysplastic cells

Question 18

VINd seen in?

Where?

Answer 18

U older

Lower 1/3 if epith (up 2/3 is normal)

Question 19

VINd tx?

Answer 19

Prevent w/ underlying tx

Surgical excision

Question 20

VINu/d F/U?

Answer 20

Post-tx colpos/inspection at 6 mo, 12 mo

then Annually for Lifetime!

Question 21

Vulvar CA U seen when?

Answer 21

Younger w/ HPV
Older from irritation/co-factors
SMOKERS

Question 22

Vulvar CA presentation? (3)

Answer 22

ASYMPT
Itching
Vulvar bleeding/pain

Question 23

SCC presentation?

Answer 23

90% are this

Variable from large cauliflower to small ulceration w/ hyperkeratosis

Question 24

BCC presentation?

Answer 24

Raised w/ center ulceration, rolled borders

Question 25

Melanoma?

Answer 25

U labia minora and clitoris

Raised, dark pigment

Question 26

Vulvar CA tx?

Answer 26

Staging on FIGO
Surg removal w/ inguinal LN
Radiation if LN involv