MEDizzy - A 53-year-old postmenopausal woman is concerned about pale

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Female Genital Tract

A 53-year-old postmenopausal woman is concerned about pale areas on her labia that have been slowly enlarging for the past year. The areas cause discomfort and become easily irritated. Physical examination shows pale gray to parchmentlike areas of skin that involve most of the labia majora, labia minora, and introitus. The introitus is narrowed. A biopsy specimen is taken and microscopically shows thinning of the squamous epithelium, a dense band of upper dermal hyaline collagen, and scattered upper dermal mononuclear inflammatory cells. What is the most likely diagnosis?

ExplanationLichen sclerosus et atrophicus is most common in postmenopausal women. Although this lesion is not premalignant, there is a 1% to 5% risk that women with this condition will later develop a squamous cell carcinoma. In contrast, lichen simplex chronicus appears grossly as leukoplakia from squamous hyperplasia and is not associated with malignancy. Extramammary Paget disease is rare; it produces reddish areas of scaling and is caused by the presence of adenocarcinoma-like cells at the dermal-epidermal junction. Human papillomavirus infection is associated with condylomata acuminata and with squamous epithelial dysplasias. Pelvic inflammatory disease results from infection of internal genital organs with organisms such as Neisseria gonorrhoeae and Chlamydia trachomatis.