6.3 Diagrammatic section of normal skin.
Signs in vulval disease
The keratinised epithelium has four layers which overlies the dermis containing adnexal structures and the vascular network (Figure 6.3). Changes will occur with disease processes which will manifest in different ways. It is important to be able to describe these lesions accurately. These are detailed in Table 6.2 and shown diagrammatically in Figure 6.4.
Figure 6.4 Features of cutaneous lesions.
Table 6.2 Types of cutaneous lesions.
| Lesion | Description | Example |
|---|---|---|
| Papule | Small palpable lesion up to 5 mm in diameter | Syringoma |
| Macule | Visible lesion up to 5 mm in diameter but not palpable | Pityriasis versicolor |
| Nodule | Palpable lesion >5 mm in diameter | Malignancy |
| Plaque | Flat palpable lesion >5 mm in diameter | Psoriasis, HSIL, lichen sclerosus |
| Ulcer | Break in epithelium that reaches into dermis | Crohn’s disease, malignancy, etc. |
| Erosion | Superficial epithelial loss, not into dermis | Erosive lichen planus |
| Vesicle | Fluid‐filled lesion up to 5 mm in diameter | Herpes simplex |
| Bulla | Fluid‐filled lesion >5 mm | Bullous pemphigoid |
| Pustule | Pus‐filled lesion | Folliculitis |
| Fissure | Linear break in epithelium which can involve dermis if deep | Mechanical hymenal fissure, psoriasis, lichen sclerosus, Crohn’s disease |
| Comedone | Keratin plug open to surface | Hidradenitis suppurativa |
References
1 1 Lynch, P.J., Moyal‐Barracco, M., Scurry, J. and Stockdale, C.2011 ISSVD Terminology and classification of vulvar dermatological disorders: An approach to clinical diagnosis. J Low Genit Tract Dis. 2012 Oct; 16(4): 339–344.
2 2 Lynch, P.J., Moyal‐Barracco, M., Bogliatto, F. et al. 2006 ISSVD classification of vulvar dermatoses: Pathologic subsets and their clinical correlates. J Reprod Med. 2007 Jan; 52(1): 3–9.
3 3 Bohl, T.J. Vulvar ulcers and erosions: A clinical approach. Clin Obstet Gynecol. 2015; 58: 492–502.
7 Investigations in Vulval Disease
Fiona M. Lewis
CHAPTER MENU
Biopsy Reasons for taking a biopsy Site of biopsy Pre-biopsy Types of biopsy Punch biopsy Incisional biopsy Elliptical biopsy Excisional biopsy Shave biopsy Local anaesthesia Technique Post-biopsy instructions Samples Documentation What do you need to tell the pathologist?
Microbiological investigation Swabs Scrapings Serology Wet mount microscopy
