3 more chances to test your diagnostic skills

September 27, 2019

Diana Curran, MD , John O.L. DeLancey, MD , Hope K Haefner, MD

Can you make the correct diagnosis and identify the best treatment plan for these common vulvar conditions?

These three cases illustrate common diseases that patients with vulvar conditions may present with. Can you make the correct diagnosis and identify the best treatment plan?

Presentation

A 62-year-old woman presents for her annual gynecologic exam, stating that she has had a 4-month history of worsening vulvar pruritus. She has treated herself with over-the-counter yeast creams and cortisone without any relief. The patient states that she has dyspareunia and cannot tolerate intercourse.

A. Lichen sclerosus	A. Antifungals
B. High-grade squamous intraepithelial lesion (HSIL)	B.Topical steroids
C. Squamous cell carcinoma (SCC)	C. Narcotics
D. Candidiasis	D. Wide local excision

Correct diagnosis: A. Lichen sclerosus

Correct treatment plan: B. Topical steroids

Presentation

A 26-year-old G0 comes to the office complaining of dysuria and painful lesions on her vulva. She has a new sexual partner as of 3 months ago and neither she nor her new partner have traveled outside of the United States. The patient takes oral contraceptives for birth control and has no known drug allergies. She denies any history of sexually transmitted infection. On physical examination, there is no inguinal lymphadenopathy. No bleeding is present with gentle touching of the lesions.

A. Chancroid	A. Biopsy
B. Behcet's disease	B. Polymerase chain reaction (PCR) of lesion
C. HSV (herpes simplex virus)	C. Prescription of oral steroids
D. Granuloma inguinale	D. Treatment with antibiotics

Correct diagnosis: C. HSV

Correct treatment plan: B. Polymerase chain reaction (PCR) of lesion

Presentation

A 77-year-old female presents for evaluation of an irritated area on her vulva. She has had a history of vulvar lichen sclerosus since her teenage years and has been only partially compliant in using topical corticosteroids.

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
E. Melanoma

Correct diagnosis: B. Squamous cell carcinoma

Correct treatment plan: D. Vulvar biopsy