JAMA Dermatology

Association of Topical Corticosteroids With Reduced Vulvar Squamous Cell Carcinoma Recurrence in Patients With Vulvar Lichen Sclerosus

This cohort study uses data from a medical record review of a dermatogynecology practice to describe the association between reduced recurrence of vulvar squamous cell carcinoma and use of topical corticosteroids in the treatment of vulvar lichen sclerosus.

Rapidly Progressive Stiffness and Nodularity of Both Hands in a Middle-aged Woman

Nodular Vulvar Lesions

A woman in her 30s presented with mildly itchy skin nodules in the vulvar region for 1 year, which occurred during pregnancy and increased gradually in size and number without any treatments. What is your diagnosis?

Vulvar Melanoma

This case report describes an ulcerated, erythematous, and hyperpigmented periurethral nodule with surrounding irregular macular hyperpigmentation.

Vulvar Lichen Sclerosus

This Patient Page describes the symptoms, diagnosis, and treatment of vulvar lichen sclerosus.

Clinical and Dermoscopic Features of Vulvar Melanosis Over the Last 20 Years

Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The differential diagnosis of melanocytic lesions includes melanoma, which creates anxiety for patients and the physicians who diagnose the condition and treat the patients. To evaluate the clinical and dermoscopic features of vulvar melanosis and their changes over time. In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Data on patient characteristics and on both the clinical and dermoscopic features of the vulvar lesions were collected. Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits. The clinical, dermoscopic, and histopathologic features of vulvar melanosis and their changes over time. This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. The most frequent location for vulvar melanosis was the labia minora (55 [43%]), followed by the labia majora (33 [26%]). In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years). This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. An association between hormonal status and vulvar melanosis may be hypothesized.

Pruritic Rash in a Woman With Endometrial Cancer

A woman in her 60s presents with a pruritic rash that initially developed on the legs and progressed to her feet, arms, hands, and trunk, with associated symptoms of a burning sensation and occasional pain. What is your diagnosis?