Abstract

Introduction: Dermatoses affecting the genitals may be of infectious, inflammatory, or neoplastic cause, and can be simply confined to the genitalia or a manifestation of a more widespread condition. Patients with cutaneous diseases of the external genitalia often initially present to their primary care provider which may be a dermatologist.

Case summary: A 56-year-old female presented with a one-year history of a gradually enlarging mass on the vulva. Continued growth of the lesion as well as bleeding and discomfort on wearing undergarments prompted consult. She was then referred by Gynecology to the Dermatology service for further evaluation. On cutaneous examination, there was a solitary, firm, fleshy tumor extending from the left labia majora into the mons pubis. Subsequent incision biopsy and histopathology revealed a well-differentiated, keratinizing squamous cell carcinoma with a strongly positive result to immunohistochemical staining with p16; this result is unusual as the keratinizing histological pattern is rarely associated with HPV. The patient was consequently referred back to Gynecology for radical vulvectomy and adjuvant therapy.

Conclusion: Dermatologists often encounter and get consulted for dermatoses of the genitalia many of which may be seemingly benign. However, there is always the risk of malignancy. Biopsy is important for early diagnosis. Comprehensive patient care of genital carcinomas requires an interdisciplinary team of dermatologists with obstetrician-gynecologists, urologists, radiotherapists, and oncologists. Furthermore, strong association of HPV with malignancy and the current availability of early screening urges not just dermatologists but all healthcare workers to encourage women to engage in preventive health programs.

Citation

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Keywords

Vulvar Squamous Cell Carcinoma, p16, Vulva, HPV, genital tumors