A 77-year-old woman presents for evaluation of an irritated area on her vulva (Figure 1). She has a history of vulvar lichen sclerosus since her teenage years and has been only partially compliant in using topical corticosteroids.
|What is the most likely Diagnosis?||The next step in your management plan is:|
|A. Differentiated vulvar intraepithelial neoplasia||A. Wide local excision of the lesion with at least 1-cm margins|
|B. Squamous cell carcinoma||B. Refer to Gynecologic Oncology|
|C. Verrucous carcinoma||C. Magnetic resonance imaging of the pelvis|
|D. Paget’s disease||D. Vulvar biopsy|
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