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Disorders of the Female Genitalia

Nonneoplastic Epithelial Disorders of the Vulva

»What is lichen sclerosus (also known as lichen sclerosus et atrophicus)?
»Describe the clinical signs of lichen sclerosus of the vulva.
»What are the symptoms of lichen sclerosus?
»Is there a need to biopsy lichen sclerosus of the vulva?
»How does one treat lichen sclerosus?
»What is the differential diagnosis of lichen sclerosus of the vulva?
»What is lichen planus?
»Are there different variants of lichen planus that affect the vulva?
»What are the clinical symptoms of vulval lichen planus?
»Is lichen planus associated with malignancy?
»How do you treat lichen planus of the vulva?
»Describe lichen simplex chronicus of the vulva.
»Psoriasis can be present on the vulva. How does it present?
»How is psoriasis of the vulva treated?
»What are other common causes of vulvar pruritus?
»Name some common vulvovaginal infections associated with pruritus?
»Compare and contrast condyloma accuminatum and molluscum contagiosum.

Vasculitic Disease of the Vulva

»What is Behçet’s disease?
»What is the treatment for Behçet’s disease?

Neoplastic Disorders of the Vulva

»What is the most common cancer of the vulva?
»Is squamous cell carcinoma of the vulva associated with a precancerous state?
»How long does it take VIN to progress to squamous cell carcinoma of the vulva?
»How does one treat VIN/SCC of the vulva?
»What is the second most common vulvar malignancy?
»How does melanoma of the vulva present?
»Are melanomas of the vulva more aggressive than other cutaneous melanomas?
»What is the treatment of melanoma of the vulva?
»What is Paget’s disease of the vulva?
»How does Paget’s disease of the vulva present?
»What is the differential diagnosis of Paget’s disease?
»How does one treat Paget’s disease of the vulva?

 
 
 

Compare and contrast condyloma accuminatum and molluscum contagiosum.

 
See Table 61-2.
Table 61-2. Condyloma Accuminatum versus Molluscum Contagiosum
   CONDYLOMA ACCUMINATAMOLLUSCUM CONTAGIOSUM
 
Clinical appearance
 
Soft fleshy cauliflower-like papules. Can be very small with a dome shape and thus difficult to differentiate from molluscum contagiosum
 
Small, dome-shaped, typically fleshcolored papules with a central umbilication when squeezed on the lateral edges
 
Etiology
 
Human papilloma virus (HPV)
HPV 6 and 11 are responsible for 90% of these lesions
 
DNA poxvirus—molluscum contagiosum virus (MCV). MCV-1 is most prevalent, MCV-2 is most commonly associated with sexually transmitted molluscum contagiosum
 
Transmission
 
Sexually transmitted
Highly contagious
 
Sexually transmitted in adults (this disease is common in children on ongenital skin, and is not thought to be sexually transmitted)

Highly contagious; known to be spread through fomites (e.g., wet towels, etc.)
 
Autoinoculation
 
Yes
 
Yes
 
Treatment
 
Imiquimod
Podophyllin
Trichloroacetic acid
Laser ablation
Cryosurgery
 
Imiquimod
Cantharidin
Trichloroacetic acid
Curettage
Laser ablation
Cryosurgery
Expectant management (many lesions will spontaneously resolve within two years)
 
Vaccine?
 
Quadrivalent vaccine for immunity against HPV
6, 11, 16, and 18
 
None