Non-neoplastic epithelial alterations of the vulva: recognition assessment and comparisons of terminologies used among the various specialties

R A Ambros, J H Malfetano, J A Carlson, M C Mihm
Modern Pathology 1997, 10 (5): 401-8
To assess the recognition of non-neoplastic epithelial alterations of the vulva and to compare terminologies used for these lesions by various specialties, we performed a clinical and dermatopathologic review of all of the cases diagnosed as non-neoplastic epithelial alterations of the vulva that were followed by one gynecologist. Forty-five initial clinical and pathologic diagnoses made by a group of 14 general surgical pathologists during a 15-year period were compared to the diagnoses made by two dermatopathologists at the time of review. Comparison of diagnoses between the three specialties revealed two types of disparities. The first represented differences in nomenclature. Although all parties frequently agreed on a diagnosis of lichen sclerosus, which represented the most frequent histologic diagnosis, the dermatopathologists did not use the term squamous hyperplasia for any case. Of greater significance was the second type of disparity identified, i.e., failure of the gynecologist and general surgical pathologist to identify uncommon dermatoses in eight cases. Concordance in diagnosis among the dermatopathologists was found in 43 of the 45 cases. These findings are consistent with the view that non-neoplastic epithelial alterations of the vulva are the same as elsewhere in the skin and that terms such as vulvar dystrophy or squamous hyperplasia are not meaningful or helpful in identifying or treating vulvar dermatoses. Unfamiliarity with specific dermatoses and the modified appearance of a dermatosis when occurring on the vulva might cause recognition failure by the gynecologist and general surgical pathologist. Entity recognition might be greatly improved if non-neoplastic vulvar lesions are approached as specific dermatoses rather than being labeled as squamous hyperplasias or vulvar dystrophies. Careful histories and physical examinations aid in identifying less common vulvar dermatoses. Referral to a dermatologist/dermatopathologist is indicated when the diagnosis is in doubt or if the response to treatment is poor.

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