Vulvar Things

Question 1

What is Vulvar intraepithelial neoplasia

Answer 1

seen in women in 40s, high risk recurrence
- HPV-associated (USUAL TYPE): warty type, basaloid type, and mixed type: assoc w/ smoking. TX=trichloroacetic acid for warts, CO2 laser ablation (depth of 1mm in non-hair bearing and 3mm in hair-bearing areas

• Non-HPV (differentiated type): assoc w/ chronic vulvar dermatoses, such as lichen sclerosis. can progress to carcinoma, recurs frequently! tx=wide local excision, radical vulvectomy if invasive carcinoma

Question 2

What are vulvar warts?

Answer 2

flat dome-shaped umbilicate lesion.
Tx: Podofilox (Condylox), Imiquimod (Aldara), Sinacatechin (Veregen), laser therapy, trichloroacetic acid, intralesional interferon

Question 3

What is lichen sclerosis?

Answer 3

affects postmenopausal and pre-pubertal
- Pruritis, burning, dyspareunia, tearing.
- Porcelain-white papules/plaques with purpura. Figure of eight shape, fusion of labia minora. tx=medium/high potency steroid (clobetasol or mometasone). Need long-term steroids

Question 4

What is lichen planus?

Answer 4

scarring inflammatory disorder of skin, oral mucosa and vulvovaginal area. Assoc w/ dysfunction of cell-mediated immunity and autoimmune disorders. <1% prevalence. Perimenopausal/menopausal.
Up to 70% have oral involvement
- Sx: dyspareunia, burning, soreness, itching, incr discharge. Looks white/reticular lacy or striae (Wickham).
- If erosive, deeply painful erythematous erosions.
- Vaginal discharge w/ inflammatory cells and parabasal and basal epithelial cells. Desquamative vaginitis!!!
Tx: hard to treat! High potency steroid BID. If resistant, topical calcineurin inhibitors (tacrolimus). If erosive w/ vaginal involvement, use intravaginal corticosteroids (Hydrocortisone acetate suppositories) + topical tx.

Question 5

What is biggest risk factor for vulvar cancer?

Answer 5

Age

Question 6

What is Paget disease?

Answer 6

group of intraepithelial neoplasias
- eczematous, red, weeping area
- associated with vulvar adenocarcinoma in 10-20% cases, often have carcinoma at another non-vulvar location
- tx: WLE. If invasive disease suspected, need radical partial vulvectomy. High rsisk recurrence