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Background: Vulvar epidermolytic hyperkeratosis (EHK) is an exceedingly rare dermatological condition, often presenting as solitary or multiple lesions in the vulvar region. Due to its clinical resemblance to other vulvar disorders, such as condyloma acuminatum, Bowenoid papulosis, and squamous cell carcinoma, vulvar EHK poses significant diagnostic challenges. While individual case reports and small case series have documented instances of vulvar EHK, comprehensive studies systematically consolidating the clinical, histopathological, and therapeutic aspects of this condition remain lacking. Objectives: To address this gap, this systematic review consolidates all available case reports and case series on vulvar EHK. The review aims to provide a comprehensive analysis of clinical presentations, histopathological features, diagnostic challenges, treatment approaches, and patient outcomes. Methods: We conducted a systematic review following the PRISMA guidelines. We searched multiple databases (PubMed, Web of Science, Scopus) for studies published up to 30 September 2024. Only case reports and case series with histopathologically confirmed vulvar EHK were included, as no higher-level studies (e.g., randomized controlled trials or cohort studies) were available due to the rarity of this condition. Exclusion criteria were male cases, oral EHK or other unrelated conditions, and literature reviews. We extracted and analyzed data on: patient demographics, time to diagnosis, anatomical distribution, clinical presentation, associated symptoms, histopathological features, patient history, risk factors, HPV status, treatment, and outcomes. Risk of bias was assessed using the CARE checklist and JBI Checklist for Case Series. Additionally, original clinical and histopathological images from our department were included to enhance the review. Results: A total of 19 studies, encompassing 30 cases of histopathologically confirmed vulvar EHK, were identified. Most cases presented with hyperkeratotic plaques and papules localized on the labia majora. Histopathological analysis consistently revealed hyperkeratosis, acanthosis, and vacuolar degeneration in the granular and spinous layers. Misdiagnosis was common, with lesions frequently mistaken for condyloma acuminatum or other vulvar neoplasms. Conservative management, including observation and topical therapies, was associated with disease stability in asymptomatic cases, while surgical excision demonstrated complete remission in all cases where it was employed. The rarity of vulvar EHK and reliance on case reports and series limit the generalizability of findings. Conclusions: Vulvar EHK is often misdiagnosed due to its similarity to malignancies and sexually transmitted infections. This review, the first of its kind, highlights the importance of prompt histopathological diagnosis to avoid the psychological impact of a cancer or sexually transmitted disease diagnosis and unnecessary, distressing, or aggressive treatments. Further research is needed to explore the role of HPV in vulvar EHK and to establish standardized diagnostic and treatment guidelines. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Objectives Methods Results Conclusion Pediatric vulvar psoriasis in girls is under‐recognized and under‐treated due to its nonspecific clinical appearance. This paper aims to describe the signs and symptoms of pediatric vulvar psoriasis and treatment strategies used by our group.A retrospective cohort study was undertaken at a private pediatric dermatology referral practice from January 2016 to December 2022. Clinical data were prospectively collected and recorded in an online patient database. Treatment regimens were individualized and titrated to clinical response.In 100 girls with vulvar psoriasis, the most common presentation was an erythematous vulvar eruption (97%) which was well‐demarcated in 52% of children and appeared as a plaque in one‐fourth. The perianal skin was involved in 48% of cases. Extragenital psoriasis was present in 69% of patients. Most children responded to initial induction treatment with moderate‐potency topical corticosteroid ointment followed by maintenance with topical tar solution. Systemic treatment was not required for purely vulvar psoriasis compared with 3% of children with extragenital psoriasis.Vulvar psoriasis in girls presents as a chronic erythematous vulvitis, with perianal involvement in half the cases, but without vaginitis. It is a remitting and relapsing skin condition that requires long‐term topical management. [ABSTRACT FROM AUTHOR]

Objectives: To explore the dermoscopic features of lichen sclerosus in different parts of the external genitalia in children. Methods: A retrospective analysis of the dermoscopic features of 42 female children with vulvar lichen sclerosus treated in the Department of Dermatology of Shanxi Children's Hospital from January 2020 to May 2023. Results: Among the 42 female children, aged 3–14 years (mean: 7.24 ± 2.43 years), the duration of vulvar lichen sclerosus ranged from 3 months to 2 years (mean: 9.83 ± 4.93 months). Clinical lesions occurred in the labia minora in 18 cases (42.9%), labia majora in 38 cases (90.5%), posterior fourchette in 36 cases (85.7%), perianal area in 13 cases (31.0%), anterior fourchette in 17 cases (40.5%), clitoris in seven cases (16.7%), and interlabial sulcus in 11 cases (26.2%). Dermoscopic findings common in the labia majora included follicular keratotic plugs, cloverleaf‐like structures, comedo‐like openings, and linear vessels (p <.05); however, purple–red globules and patches and white linear streaks were more common in the posterior fourchette (p <.05), whereas dotted vessels were more common in the labia minora (p <.05). Conclusions: Common dermoscopic findings in pediatric vulvar lichen sclerosus were yellow‐white structureless areas, white linear streaks, follicular keratotic plugs, and cloverleaf‐like structures; yellow‐white structureless areas and white linear streaks showed the highest specificity. The dermoscopic findings varied among different affected areas, which provides a basis for further understanding of the characteristics of different sites of vulvar lichen sclerosus in the pediatric population. [ABSTRACT FROM AUTHOR]

Background: Due to the lack of a large series of benign and malignant vulvar lesions, the features of dermoscopy are not well established. Objective: The aim of our study was to describe the epidemiological profile and the clinical and dermoscopic characteristics that may indicate malignancy or benignity in vulvar hyperpigmentation. Materials and Methods: From June 2020 to June 2023, we conducted a retrospective, prospective study involving 42 patients with 59 pigmented lesions. Results: The parallel, homogeneous, and globular patterns were observed in benign lesions (nevi, lentigo, melanosis). The cerebriform pattern was observed in seborrheic keratosis and Bowen's disease (BD). In cases of BD, we also observed white, structureless areas, glomerular vessels, a homogeneous brownishgray area, and brown dots. Conclusion: Good clinico-dermoscopic correlation should guide the diagnosis and management of pigmented vulvar lesions. Dermoscopy may be helpful in distinguishing between a benign lesion and a malignant lesion, yet in cases of doubt, a biopsy may be necessary. [ABSTRACT FROM AUTHOR]

This article discusses the use of reflectance confocal microscopy (RCM) as a diagnostic tool for vulvar lichen sclerosus (VLS) and vulvar vitiligo (VV) in juvenile Chinese girls. VLS and VV have similar clinical appearances, but RCM can reveal distinct features that aid in diagnosis. The study examined 28 patients, with 17 having VLS and 11 having VV. The results showed that VLS is characterized by structural disorder, fibrous material deposits, and larger cellular structures, while VV is characterized by weakened dermal papillary rings. The authors suggest that RCM can be used to support clinical diagnosis of VLS and VV. [Extracted from the article]

Condyloma latum is a typical lesion of secondary syphilis，which usually appears in the vicinity of the initial chancre. It is found that treponema pallidum load in condyloma latum is significantly higher than that in other secondary syphilis. We report a case of mesosyphilis presented as giant flat condyloma latum in vulvar and perianal areas. A 17-year female patient came to our clinic，complaining of plaques in vulvar and perianal areas more than 2 months. Physical examination showed giant red moist plaques in vulvar and perianal areas. The titer of non-specific antibody for syphilis was 1∶64 and the specific antibody test for syphilis showed a value of 189.000 COI. The patient was diagnosed as secondary syphilis and treate with benzathine penicillin. The rash subsided after 3-week treatment. This case of condyloma latum with giant red plaques was easily misdiagnosed as condyloma acuminatum.

The patient, a 20-year-old nulligravida, presented with a progressive swelling on the right side of her vulva over the past three years. She also reported dull, aching pain, particularly during long walks. Upon examination, the patient appeared comfortable, and her vital signs were within normal limits. Genitourinary examination revealed a right vulvar mass, 12 cm by 7 cm, which was movable, soft in consistency, and non-tender. Subsequent inguinovulvar ultrasonography confirmed the presence of a compressible soft-tissue mass measuring 10 × 7 × 4 cm, consistent with a diagnosis of lipoma. Surgical excision resulted in a significant improvement in the patient's condition and she was discharged from hospital.

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Vulvar squamous cell carcinoma (vSCC) is a rare tumor with a good prognosis when treated at a localized stage. However, once regional/distant metastasis occurs, vSCC can be rapidly fatal. Thus, it is important to identify tumor prognostic features so that high-risk cases can be prioritized for further diagnostic workup and treatment. To estimate the risk of regional/distant metastasis at presentation and sentinel lymph node status for vSCC based on histopathologic characteristics. A retrospective cohort study of 15,188 adult vSCC cases from the National Cancer Database diagnosed from 2012 to 2019. We provide specific estimates of the risk of clinically positive nodes and metastatic disease at presentation and sentinel lymph node positivity according to tumor size, moderate/poor tumor differentiation, and lymph-vascular invasion. These histopathologic factors were all significantly associated with the tested clinical outcomes in a multivariable analysis. Moderate (hazard ratio, 1.190; P <.001) and poor differentiation (hazard ratio, 1.204; P <.001) and lymph-vascular invasion (hazard ratio, 1.465; P <.001) were also associated with significantly poorer overall survival. Data on disease-specific survival not available in the data set. We demonstrate the association of the histopathologic characteristics of vSCC with clinically important outcomes. These data may provide individualized information when discussing diagnostic/treatment recommendations, particularly regarding sentinel lymph node biopsy. These data may also guide future staging and risk stratification efforts for vSCC. [ABSTRACT FROM AUTHOR]

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis of unknown pathogenesis, characterized by porcelain‐white atrophic plaques around the vulvar and anal areas in girls. With this communication, we performed the study on 16 female girls with clinically and histologically confirmed VLS, described the main identifying characteristics of the lesions in reflectance confocal microscopy (RCM) and elucidated the corresponding relationship between RCM findings and histology. We recommend RCM, a noninvasive technique, as a complementary diagnostic tool for VLS. [ABSTRACT FROM AUTHOR]

Objectives Our aim was to explore the performance of TRPS1 as an immunohistochemical diagnostic marker; find the optimal conditions for its use in breast carcinomas, especially triple-negative breast cancers (TNBCs); and compare its results in carcinomas of a select few organ sites, with an emphasis on gynecologic tumors. Methods Tissue microarrays from breast carcinomas (n = 197), endometrial adenocarcinomas (n = 69), ovarian tumors (n = 250), vulvar squamous cell carcinomas (n = 97), pancreatic ductal adenocarcinomas (n = 20), and gastric adenocarcinomas (n = 12) were stained with TRPS1 using 2 different conditions (protocol 1: high pH; protocol 2: low pH). Breast carcinomas consisted of hormone receptor (HR)–positive/ERBB2 (formerly HER2 or HER2/neu)–negative (n = 53) samples, HR-positive/ERBB2-positive (n = 6) samples, and TNBCs (n = 138). Results Comparing TRPS1 results in breast carcinomas vs tumors from other organ sites, the sensitivity of TRPS1 was 91% and 87%, respectively, while the specificity was 66% and 74% for protocol 1 and 2, respectively. For TNBCs vs gynecologic tumors, the sensitivity of TRPS1 was 89% and 85%, respectively, while the specificity was 65% and 73%, respectively. Conclusions TRPS1 stains approximately 90% of breast carcinomas but also up to 71% of endometrial carcinomas, albeit with a weaker median expression. Our data show that although TRPS1 is a highly sensitive marker for TNBCs, it is not as highly specific as previously reported. [ABSTRACT FROM AUTHOR]

Manon Dupont,1 Muriel Parent,2 Olivier Vanhooteghem1 1Dermatology Department, CHU UCL Namur, Site Sainte Elisabeth, Namur, 5000, Belgium; 2Department of Pathology, Institute of Pathology and Genetics (IPG), Gosselies, 6041, BelgiumCorrespondence: Olivier Vanhooteghem, Email ovanhooteghem@hotmail.comAbstract: Dowling Degos disease (DDD) is a rare genodermatosis that manifests itself as acquired, reticulated hyperpigmentation of the folds. We report the case of a 45-year-old woman who presented since the age of 30 with hyperpigmented macules of reticulated appearance of vulvar, perianal and bilateral axillary location associated with hidradenitis suppurativa (HS) at Hurley stage 2 of later onset. DDD is classically described in the flexural folds and, to our knowledge; less than a dozen cases of vulvar location are published in the literature. We postulate that DDD is responsible for the development of HS in susceptible patients. Indeed, this association seems to be explained by a common pathophysiological mechanism, targeting the Notch signalling pathway, involved in the proliferation and differentiation of epidermal cells that can induce the development of HS. DDD should be considered as a comorbid factor of HS.Keywords: hidradenitis suppurativa, Dowling Degos, vulvar, hyperpigmentation, comorbidities

Purpose: Vulvar lichen sclerosus (LS) is a chronic, progressive, autoimmune dermatologic condition that causes cutaneous changes accompanied by pruritus and pain. There remains a small population with vulvar LS refractory to topical corticosteroids. Injection of platelet-rich plasma (PRP) has been reported to have positive effects on tissue repair. The aim of this pilot study was to evaluate changes in symptom scores during and after PRP vulvar infiltration. Methods: Three PRP infiltrations were administered to 28 female postmenopausal patients with biopsy-proved LS with unsatisfactory response to steroid therapy. Change in score according to the Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) was measured on six occasions over the course of a year. We used growth curve modeling to measure change over the period of the study. Results: Women in our study experienced a statistically significant improvement in auto-assessed symptoms of vulvar lichen sclerosus, and this improvement appears to be maintained throughout the monitoring year. Conclusion: Platelet-rich plasma may have a role in symptom relief in certain cases of patients with LS that do not respond to first-line therapy. [ABSTRACT FROM AUTHOR]

Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment of patients with labial varices, with a focus on interventional radiologic management. [ABSTRACT FROM AUTHOR]

Granular cell tumors (GCTs) (Abrikossoff's tumors) are rare neoplasms derived from Schwann cells. Immunohistochemistry remains the most useful instrument for diagnosing GCTs. Complete surgical excision has been demonstrated to be curative for benign lesions. However, long-term follow-up in these patients is strongly recommended. [ABSTRACT FROM AUTHOR]

Compared with sun-exposed melanomas, less is known regarding the pathogenesis of sun-protected melanomas. Sun-protected melanomas share many epidemiologic factors, but their genetic heterogeneity is not well studied. We investigated the genomic profile of acral, mucosal, and vulvovaginal melanomas. We hypothesize that mucosal melanomas, recognized for their uniquely aggressive clinical behavior, have distinct genomic features. We performed whole transcriptome messenger RNA and DNA (1711 genes) sequencing, messenger RNA expression profiling, tumor mutational burden, ultraviolet signature, and copy number variants analysis on 29 volar/digital acral, 7 mucosal, and 6 vulvovaginal melanomas. There was significant genetic heterogeneity, particularly in acral melanomas, with 36% having BRAF alterations, whereas other melanomas had none (P =.0159). Nonzero ultraviolet signatures were more frequent in acral melanomas, suggesting greater ultraviolet involvement. Mucosal melanomas formed a distinct group with increased expression of cell cycle and proliferation genes. Various targetable aberrations were identified, such as AURKA and ERBB2 , in mucosal and acral melanomas, respectively. The sample size was a small. There is significant genetic heterogeneity among sun-protected melanomas. Mucosal melanomas have upregulation in cell cycle and proliferation genes, which may explain their aggressive behavior. Ultraviolet radiation plays some role in a subset of acral but not other melanomas. [ABSTRACT FROM AUTHOR]

Weiwei Wu,1,&ast; Lengbing Sun,2,3,&ast; Jiejie Lu,2 Xianxu Yang,2 Qiao Liu,3,4 Junzhi Wang5 1Department of Plastic and Dermatological Surgery, The Fifth People’s Hospital of Hainan Province, Haikou, People’s Republic of China; 2Department of Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, People’s Republic of China; 3School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China; 4Department of Dermatology,The Second Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, People’s Republic of China; 5First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qiao Liu; Junzhi Wang, Email drliuqiao@163.com; drvolodia@163.comAbstract: Verruciform xanthoma (VX) is a rare, benign, mucocutaneous, verrucous, papillary lesion. This paper retrospectively summarizes clinical and pathologic features of 32 vulvar verruciform xanthoma reported from China and abroad. The skin lesions are generally single, mainly in labia minora, clitoris and fourchette with partly extending to the groin, buttocks and anus. The possible inducing factors include long-term scratching, local itching, severe lymphedema or lymphangioma circumscriptum. Severe cutaneous trauma and chronic inflammation may be the main causes. Clinically, it can easily be misdiagnosed as condylomata acuminata, squamous cell carcinoma, bowenoid papulosis, etc. It is reported to be related to underlying disorders. The main treatment is complete resection.Keywords: verruciform xanthoma, vulvar, clinical features, immunohistochemistry, treatment, etiology

It has been suggested that a primary tumor can "prepare" the draining of lymph nodes to "better accommodate" future metastatic cells, thus implying the presence of a premetastatic lymph node niche. However, this phenomenon remains unclear in gynecological cancers. The aim of this study was to evaluate lymph-node draining in gynecological cancers for premetastatic niche factors, such as myeloid-derived suppressor cells (MDSCs), immunosuppressive macrophages, cytotoxic T cells, immuno-modulatory molecules, and factors of the extracellular matrix. This is a monocentric retrospective study of patients who underwent lymph-node excision during their gynecological-cancer treatment. In all, 63 non-metastatic pelvic or inguinal lymph nodes, 25 non-metastatic para-aortic lymph nodes, 13 metastatic lymph nodes, and 21 non-cancer-associated lymph nodes (normal controls) were compared for the immunohistochemical presence of CD8 cytotoxic T cells, CD163 M2 macrophages, S100A8/A9 MDSCs, PD-L1+ immune cells, and tenascin-C, which is a matrix remodeling factor. PD-L1-positive immune cells were significantly higher in the control group, in comparison to the regional and distant cancer-draining lymph nodes. Tenascin-C was higher in metastatic lymph nodes than in both non-metastatic nodes and control lymph nodes. Vulvar cancer-draining lymph nodes showed higher PD-L1 values than endometrial cancer and cervical cancer-draining lymph nodes. Endometrial cancer-draining nodes had higher CD163 values and lower CD8 values, compared to vulvar cancer-draining nodes. Regarding regional draining nodes in low- and high-grade endometrial tumors, the former showed lower S100A8/A9 and CD163 values. Gynecological cancer-draining lymph nodes are generally immunocompetent, but vulvar cancer draining nodes, as well as high-grade endometrial cancer draining nodes, are more susceptible to harboring premetastatic niche factors. [ABSTRACT FROM AUTHOR]

Background: Vulvar lichen sclerosus (VLS) in girls presents with itching, dysuria, and constipation and may result in the loss of vulvar architecture. In patients with an ambiguous clinical presentation, reflectance confocal microscopy (RCM) could be a helpful noninvasive diagnostic tool. The aim of this study was to describe the RCM characteristics of VLS and explore the clinical application value of RCM in therapeutic monitoring. Methods: Sixteen patients with VLS were included in the study. All patients were periodically evaluated clinically with RCM, and different treatment regimens were given based on the patient's clinical appearances and RCM features. Results: Some major key diagnostic features of VLS can be observed by RCM, including round to oval cyst‐like structures with medium‐to‐low‐refractive keratinoid substances (75%), thinning of the epidermal thickness (100%), destruction of the ring‐like structures around dermal papillae (100%), disorderly distributed coarse medium‐refractive fibrous material (100%),polygonal, plump, high‐refractive cellular structures and linear low‐refractive canalicular structures (100%). All of these characteristics had a high correspondence with histopathological features. The clinical manifestations improved after individualized treatment regimens based on the clinical appearances and RCM features. Conclusion: RCM allows the visualization of major key diagnostic features of VLS and represents a valid option for objective therapeutic monitoring. [ABSTRACT FROM AUTHOR]

Objective: Vulvar squamous cell carcinoma (VSCC) can be either HPV-dependent (HPVd) or HPV-independent (HPVi). HPVd VSCC typically occurs in younger women, has a more favorable prognosis, and develops from high-grade squamous intraepithelial lesions (HSIL). HPVi VSCC predominantly affects older women and arises within areas of chronic inflammation, particularly lichen sclerosis (LS). We utilized sequencing-based spatial transcriptomics to explore gene expression in a cohort of patients with HPVi and HPVd VSCC., Methods: We analysed gene expression in distinct areas (SCC, inflammation, LS, HSIL) from four early-stage VSCC cases (two HPVi, two HPVd) using the 10× Genomics Visium spatial transcriptomics platform. Cell-specific type expression was inferred using CIBERSORTx., Results: 28,183 Visium spots were detected; each contained an estimated 20-50 cells. Reads per spot ranged from 9903 to 68,527. More genes were upregulated in HPVd (N = 601) than HPVi (N = 72) with distinct differences in Keratin and Collagen genes between etiologies. Gene expression was strikingly similar between SCC and adjacent inflammatory areas, regardless of etiology. IL-17 signaling was upregulated in HPVd samples. Surprisingly, CIBERSORTx inferred significantly more CD45+ cells in HPVi tissues than HPVd, especially CD4+ resting memory and follicular helper T cells in SCC areas. Immune cells moved from resting states in the pre-invasive tissues to activated states in the SCC and peri-tumoral inflammatory areas., Conclusions: This study represents the first application of spatial transcriptomics in VSCC, with significantly more immune cells identified in HPVi SCC than in HPVd SCC. These data will act as a baseline for future studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Patients with vaginal, vulvar, penile or anal cancer experience deteriorated psychosocial functioning and decreased Quality of Life (QoL). The aims of this study were to explore (1) the challenges and controversies patients experience in managing vaginal, vulvar, penile or anal cancer; their unmet needs; and how this affects their psychosocial functioning and (2) the gaps health care professionals (HCPs) experience in providing psychosocial support and potential improvements in care. Methods: Semi‐structured interviews with patients with vaginal, vulvar, penile or anal cancer and with HCPs were conducted. All interviews were transcribed verbatim and thematically analysed. Results: Fourteen patients (86% female; mean age 55.5) and 12 HCPs (75% female; mean age 46.4) participated. Four themes were identified: (1) recognisable symptoms but unfamiliar diagnosis, (2) 'double hit' has severe impact on psychosocial functioning, (3) personal and tailored information is important but not guaranteed and (4) all‐encompassing care to improve psychosocial functioning and QoL. Conclusion: Patients with vaginal, vulvar, penile or anal cancer encounter a lack of awareness and knowledge about their rare cancer type, difficulties regarding communication and long‐term changes in body image and sexuality. Awareness of symptoms should be raised and psychosocial care should be offered on a structural basis. [ABSTRACT FROM AUTHOR]

Genitogluteal porokeratosis is a disorder of keratinization that may present in men in their fourth decade of life. We describe a 52-year-old human immunodeficiency virus (HIV)-positive man with history of anal squamous cell carcinoma who developed verrucous lesions on the buttocks and genitals. The buttock lesions presented shortly after radiotherapy for anal carcinoma a decade prior, whereas the genital lesions presented three months prior in areas treated with injectable medication for erectile dysfunction. Skin biopsy revealed a cornoid lamella, leading to the diagnosis of genitogluteal porokeratosis. The buttock lesions were treated with shave excision and the genital lesions were treated with topical agents. Using the PubMed database, a literature search was performed with combinations of the following key words: acuminata, condyloma, cornoid lamella, genital, genitogluteal, HIV, penile, porokeratosis, verrucous, vulvar. The generated papers and their references were reviewed. To the best of our knowledge, we present the first reported case of genitogluteal porokeratosis in an HIV-positive man. Notably, these lesions developed in sites of prior radiation or injection. This condition should be included in the differential diagnosis of chronic lesions of the genitals and buttocks in patients with HIV and/or history of radiation treatment and/or trauma to the genitogluteal region.

Investigate the utilization and outcomes of lymphadenectomy/ sampling (LND) for patients with vulvar melanoma. Patients diagnosed between 2004–2015 with vulvar melanoma with known depth of tumor invasion and no distant metastases were identified in the National Cancer Database. Based on pathology report patients who underwent inguinal lymph node sampling/dissection were identified. Clinico-pathological characteristics and overall survival were compared between the two groups. A total of 1286 patients were identified; 62.8 % (n = 808) underwent lymphadenectomy/ sampling. Patients who underwent lymphadenectomy/ sampling were younger (median 66 vs 76 years, p < 0.001), more likely to have private insurance (42.9 % vs 27.8 %, p < 0.001), present with tumor ulceration (65.9 % vs 58.6 %, p = 0.01), have deeper tumor invasion (p < 0.001) and undergo radical vulvectomy (26.4 % vs 12.1 %, p < 0.001). Patients who underwent lymphadenectomy/ sampling had better overall survival compared to those who did not (median 49.08 vs 35.91 months respectively, p < 0.001). After controlling for patient age, race, insurance status, comorbidities, presence of tumor ulceration and Breslow depth of invasion performance of lymphadenectomy/ sampling was associated with better survival (hazard ratio: 0.78, 95 % confidence intervals: 0.67, 0.92). For patients with vulvar melanoma with at least 1 mm invasion lymphadenectomy/ sampling was associated with better overall survival likely secondary to stage migration. • Patients with VM undergoing LND had better OS compared to those without LND • No difference was detected in the OS for depths of invasion of ≤ 1 mm • The OS was significantly longer in patients with LND after adjusting for risk factor [ABSTRACT FROM AUTHOR]

Abstract Background Solitary fibrous tumours (SFTs) in the female genital tract are uncommon. Resection of these tumours is controversial because it can cause life-threatening haemorrhage. We report a case of vulvar SFT that was excised in a combined abdominal-sacral approach after preoperative embolisation. Case presentation At another hospital, an inoperable intrapelvic tumour was diagnosed in a 34-year-old woman. Computed tomography and magnetic resonance imaging showed that the uterus, urinary bladder and rectum were compressed laterally by a pelvic tumour with a maximum diameter of 11 cm. This mass was hypervascular and had a well-defined border. Transperineal biopsy was performed, and immunostaining revealed that the mass was an SFT. The tumour was supplied by feeding vessels from the right iliac arteries. First, we embolised the feeding vessels. Second, we performed surgical resection in a combined abdominal-sacral approach; no blood transfusion was necessary, and no perioperative complications occurred. The final pathological diagnosis was SFT that was positive for CD34 and signal transducer and activator of transcription 6 according to immunohistochemical staining. Conclusion During a year of follow-up, the disease did not recur. Treatment of pelvic SFT should aim at complete resection through various approaches after careful measures are taken to prevent haemorrhage.

Full-body skin exams (FBSE) play an integral role inearly detection and treatment of skin cancer. Promptdetection of melanoma is especially importantas survival outcomes decrease significantly withpresentation of advanced disease. Given thatmelanoma may grow in areas of skin with little to nosun exposure, genital melanomas are a recognizedentity in cutaneous oncology.

PurposeThree-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy.Material and methodsThree brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic.ResultsPatient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences.ConclusionsWe established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators.

Abstract Background Combined with cancer screening programs, vaccination against human papillomavirus (HPV) can significantly reduce the high health and economic burden of HPV-related disease in Japan. The objective of this study was to assess the health impact and cost effectiveness of routine and catch-up vaccination of girls and women aged 11–26 years with a 4-valent (4vHPV) or 9-valent HPV (9vHPV) vaccine in Japan compared with no vaccination. Methods We used a mathematical model adapted to the population and healthcare settings in Japan. We compared no vaccination and routine vaccination of 12–16-year old girls with 1) 4vHPV vaccine, 2) 9vHPV vaccine, and 3) 9vHPV vaccine in addition to a temporary catch-up vaccination of 17–26 years old girls and women with 9vHPV. We estimated the expected number of disease cases and deaths, discounted (at 2% per year) future costs (in 2020 ¥) and discounted quality-adjusted life years (QALY), and incremental cost effectiveness ratios (ICER) of each strategy over a time horizon of 100 years. To test the robustness of the conclusions, we conducted scenario and sensitivity analyses. Results Over 100 years, compared with no vaccination, 9vHPV vaccination was projected to reduce the incidence of 9vHPV-related cervical cancer by 86% (from 15.24 new cases per 100,000 women in 2021 to 2.02 in 2121). A greater number of cervical cancer cases (484,248) and cancer-related deaths (50,102) were avoided through the described catch-up vaccination program. Routine HPV vaccination with 4vHPV or 9vHPV vaccine prevented 5,521,000 cases of anogenital warts among women and men. Around 23,520 and 21,400 diagnosed non-cervical cancers are prevented by catch-up vaccination among women and men, respectively. Compared with no vaccination, the ICER of 4vHPV vaccination was ¥975,364/QALY. Compared to 4vHPV, 9vHPV + Catch-up had an ICER of ¥1,534,493/QALY. Conclusions A vaccination program with a 9-valent vaccine targeting 12 to 16 year-old girls together with a temporary catchup program will avert significant numbers of cases of HPV-related diseases among both men and women. Furthermore, such a program was the most cost effective among the vaccination strategies we considered, with an ICER well below a threshold of ¥5000,000/QALY.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy‐resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms‐of‐action of fat grafting to treat LS. [ABSTRACT FROM AUTHOR]

Objective: Sentinel lymph node dissection (SLND) spares most patients diagnosed with clinically early-stage vulvar cancer from undergoing complete inguinofemoral lymphadenectomy (IFLND). We sought to evaluate the intraoperative examination of frozen sentinel lymph node (SLN) sections to assess the need for IFLND. Methods: We identified patients with vulvar cancer treated at a tertiary referral center between January 2006 and December 2019 who either underwent SLND or met the eligibility criteria to receive SLND. All patients were restaged according to the International Federation of Gynaecology and Obstetrics (FIGO) 2009 guidelines. The records of each patient were reviewed for disease characteristics, follow-up status, patient demographics, SLN eligibility, and surgical and pathologic variables. Results: Of 142 eligible patients, 76 underwent SLND (53.5%) for a total of 118 groins assessed. We found no statistically significant differences in characteristics between the cohorts that received or lacked SLN examination. The SLN was detected in 90.8% (95% Confidence Interval (CI): 81.9%-96.2%) of patients. SLNs of 52 patients were sent for frozen section, and the results were used to direct further surgical intervention. The results of the frozen section pathology and the final pathology report exhibited a high degree of correlation per patient (100%) and per groin (98.7%). The 1 incorrect groin was negative on frozen but positive on final pathology and therefore no patients received an incorrect complete groin dissection. We observed no statistically significant differences in recurrence-free survival or overall survival rates between those patients who received or did not receive SLND. Conclusions: The use of intraoperative frozen section is appropriate for assessing node status at time of initial surgery. The use of this method decreases the incidence of reoperation by identifying those patients who warrant immediate IFLND. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of interest None disclosed.

Fordyce angiokeratoma is a benign skin neoplasm, characterized by erythematous-violet keratotic papules with mamillated surface, which follows a chronic and minimally symptomatic course. However, symptoms can be related such as itching, burning, bleeding, dyspareunia; aesthetic and social concerns may prompt request for treatment. The condition mainly affects men and usually occurs in the scrotum, but rarely may occur in women. A 30-year-old woman with liver cirrhosis and portal hypertension is described. Over a period of two years she developed multiple angiokeratomas of the vulva, complicated by frequent bleeding. Histopathologic analysis of the lesion confirmed the diagnosis of angiokeratoma and all lesions were surgically removed. The results of the treatment were very satisfactory, with no relapses or complications.Angioqueratoma de Fordyce é uma dermatose incomum que compõe o grupo das neoplasias cutâneas benignas, caracterizando-se pelo aparecimento de lesões papuloceratósicas, eritemato-violáceas de superfície mamilonada, que apresentam curso crônico e oligossintomático. No entanto, outros sintomas podem estar associados, como prurido, ardência, sangramento e dispareunia, além de problemas estéticos e de ordem social. Afeta principalmente homens, acometendo a região escrotal, sendo raro seu surgimento em mulheres. Relata-se caso de uma paciente com 30 anos de idade, portadora de cirrose hepática e hipertensão portal evoluindo há 2 anos com múltiplos angioqueratomas na vulva de sangramento frequente. A análise histopatológica confirmou o diagnóstico de angioqueratoma e a paciente foi submetida à exérese cirúrgica das lesões. Os resultados terapêuticos foram satisfatórios, sem recidivas ou complicações.