Second, whereas condylomas tend to be firmer, randomly distributed, and not confined to the vulvar vestibule, VP tends to be softer and symmetrically distributed within the confines of the inner labia minora and vestibule ( Muhammed et al., 2019).Īlthough clinical appearance and workup alone are usually sufficient to make a diagnosis of VP, should histopathological analysis be pursued, prominent fibrovascular cores covered by mature squamous epithelium are characteristic of VP.
First, whereas the filiform projections of condylomas tend to fuse at their base, the bases of individual projections of VP remain separate and distinct. The presence of grouped papules in the vulva invokes HPV-associated condylomas as part of the differential, but VP can be distinguished from condylomas by two key features. Condylomas (left) are firmer, with fused bases, and are asymmetrically distributed.Ĭlinically, VP is characterized by the presence of multiple frond-like mucosal papillae in a linear and symmetric distribution within the vulvar vestibule and inner labia minora. Vestibular papillomatosis (right) is symmetrical and has soft, finger-like projections, each with its own insertion point.
These entities include vestibular papillomatosis (VP), variation in vulvar dimension, urethral caruncle (UC), seborrheic keratosis (SK), syringoma, epidermal inclusion cyst (EIC), vestibular gland cyst (VGC), and hidradenoma papilliferum (HP).Ĭondyloma acuminatum (left) versus vestibular papillomatosis (right). Thus, the purpose of this review is to highlight some of the most commonly encountered anatomic variants and benign neoplasms of the vulva, distinguish them from key pathologic mimickers, and provide reassurance as to what may constitute normal vulvar variations. Unfortunately, the current literature on benign neoplasms and anatomic variants of the vulva is both limited in scope and principally found in gynecologic journals not widely read by dermatologists. Dermatologists’ ability to recognize benign variants of the vulva is critical, not only to reduce patient anxiety, but also to minimize unnecessary workup. That said, vulvar lesions can often elicit an elevated level of anxiety for patients and dermatologists alike-this is likely due to the broad range of etiologies of vulvar lesions, some of which carry significant risk of morbidity, but many of which are benign ( Kelekçi et al., 2016).
As both a gynecologic and dermatologic organ, the vulva lies well within the purview of the dermatologist's practice. The vulva refers to the external female genitalia and includes the mons pubis, labia majora, labia minora, clitoris, vulvar vestibule, urethral meatus, vaginal introitus, and Bartholin's and Skene's vestibular glands ( Nguyen and Duong, 2020).
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