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The diagnosis is always based on a careful inspection and a targeted biopsy of a visible vulvar lesion. The type and distribution of lesions varies among the two different types of VIN. In the Usual type VIN, seen more frequently in young patients, lesions tend to be multifocal over an otherwise normal vulvar skin.
Examination of the vulva is part of the gynecologic evaluation and should include a thorough inspection of the perineum, including areas around the clitoris and urethra, and palpation of the Bartholin's glands. [21] The exam may reveal an ulceration, lump or mass in the vulvar region. Any suspicious lesions need to be sampled, or biopsied.
Bartholin gland carcinoma is a type of cancer of the vulva arising in the Bartholin gland. [2] It typically presents with a painless mass at one side of the vaginal opening in a female of middle-age and older, and can appear similar to a Bartholin cyst. [2]
Signs and symptoms may include a feeling of pressure, painful intercourse or bleeding. [12] Most vaginal tumors are located during a pelvic exam. Ultrasonography, CT and MRI imaging is used to establish the location and presence or absence of fluid in a tumor. [13] [14] Biopsy provides a more definitive diagnosis. [15]
Similar clinical lesions have been reported in male genitalia affecting the penis and the scrotum. [2] Vulvar CD bears no typical symptoms and is only diagnosed and associated with gastrointestinal CD based on vulvar ulcers and hypertrophic lesions. Some patients do, however, report vulvar pain, pruritus, dyspareunia or dysuria. [3] [4]
Vulvar Paget's disease affect women and presents as erythematous (red), eczematous lesions. [10] It is itchy and sometimes pain can be associated with the affected area. [ 10 ] The lesion is clearly separated from normal skin in most cases, and sometimes scattered areas of white scale can be present, giving a "strawberries and cream" appearance.
Imaging and histopathological examination is used for diagnosis of the disease. Furthermore, treatment of the disease is to surgically remove the tumor. [10] Vulvar leiomyomas are one the most prominent types of genital leiomyomas. Lesions to the vulva may be up to 15 cm in length and they are reported to be acutely painful.
Angiokeratoma of Fordyce (also known as "Angiokeratoma of the scrotum and vulva," though not to be confused with Fordyce's spots) [5] is a skin condition characterized by red to blue papules on the scrotum or vulva. Solitary angiokeratoma is a small, bluish-black, warty papule that occurs predominantly on the lower extremities. [5]: 590