Vulval Pathology

Question 1

Name the condition:
Signs - pale atrophic areas, purpura (ecchymosis), fissuring, erosions, hyperkeratosis, ‘figure of eight’ loss of architechture

Answer 1

Lichen sclerosus

BASHH 2015

Question 2

Percentage of lichen sclerosus that develops to squamous cell carcinoma?

Answer 2

4% (TOG & RCOG/BGCS 2014)

<5% (BASHH 2015)

Question 3

Name the condition:

Histopathology - epidermal atrophy, hyperkeratosis with sub-epidermal hyalinisation of collagen and lichenoid infiltrate

Answer 3

Lichen sclerosus

BASHH 2015

Question 4

Very potent topical steroid

Answer 4

Very potent - clobetasol prorionate (Dermovate)
Very potent with antibacterial and antifungal - Dermovate NN (clobetasol with neomycin and nystatin)
Moderate - betamethasone valerate 0.025%
Mild - hydrocortisone 1%
(BASHH 2015)

Question 5

Name the condition:
Signs - papules on keratinised anogenital skin, with or without striae on inner vulva, hyperpigmentation follows resolution

Answer 5

Lichen planus - classical

BASHH 2015

Question 6

Name the condition:

Signs - affects perineum and perianal area, thickened warty plaques, may become ulcerated and painful

Answer 6

Lichen planus - hypertrophic

BASHH 2015

Question 7

Name the condition:
Signs - mucosal surfaces are eroded, at the edges of erosions epithelium is mauve/grey, pale network (Wickham’s striae) sometimes seen, friable telangiectasia with patchy erythema

Answer 7

Lichen planus - erosive

BASHH 2015

Question 8

Percentage of lichen planus that develops to squamous cell carcinoma?

Answer 8

Up to 3%

BASHH 2015

Question 9

Which condition involves the vagina?

• Lichen sclerosus
• Lichen planus

Answer 9

Lichen planus

BASHH 2015

Question 10

Name the condition:

Histopathology - irregular saw-toothed acanthosis, increased granular layer and basal cell liquefaction

Answer 10

Lichen planus

BASHH 2015

Question 11

Emollient soap substitute

Answer 11

Hydramol

BASHH 2015

Question 12

Mild steroid

Answer 12

Very potent - clobetasol prorionate (Dermovate)
Very potent with antibacterial and antifungal - Dermovate NN (clobetasol with neomycin and nystatin)
Moderate - betamethasone valerate 0.025%
Mild - hydrocortisone 1%
(BASHH 2015)

Question 13

Moderate steroid

Answer 13

Very potent - clobetasol prorionate (Dermovate)
Very potent with antibacterial and antifungal - Dermovate NN (clobetasol with neomycin and nystatin)
Moderate - betamethasone valerate 0.025%
Mild - hydrocortisone 1%
(BASHH 2015)

Question 14

Name the condition:

Signs - raised white, erythematous or pigmented lesions occur and may be warty, moist or eroded

Answer 14

Vulval intraepithelial neoplasia (VIN)

BASHH 2015

Question 15

Percentage of VIN that develops to squamous cell carcinoma?

Answer 15

9 - 18.5%

BASHH 2015

Question 16

Name the condition:
Histopathology - loss of organisation of squamous epithelium with a variable degree of cytological atypia which is graded as undifferentiated or differentiated and by depth

Answer 16

Vulval intraepithelial neoplasia (VIN)

BASHH 2015

Question 17

Topical local anaesthetics for vulvodynia

Answer 17

5% lidocaine ointment or 2% lidocaine gel

BASHH 2015