I came across an interesting case last week that I would like to share with you. A female patient 58 years old was referred to me and my colleague, Dr Eman El Nabarawy, with a lesion on the vulva that had been there for 15 years. The patient was diagnosed by her gynecologist to have genital wart (condyloma), in spite of the much localized nature of the lesion and the very long duration. The patient being a widow for 5 years with no sexual relations was not convinced and seeked the advice of a dermatologist who sent her to me for biopsy.
The lesion was in the form of a plaque with a papillomatous smooth surface and a central fibroepithelial polyp (skin tag) like part. The biopsy revealed mild hyperkeratosis with focal parakeratosis, acanthotic papillomatous epidermis with fibrovascular cores and sparse perivascular lymphohistiocytic infiltrate. No koilocytes were detected. I diagnosed this case with my colleague as squamous papillomatosis of the vulva.
It was a nice opportunity to revise the differential diagnosis of verrucous lesions on the vulva. Interestingly to say we found many lesions that can appear on the vulva that can mimic condyloma on first sight such as: squamous papillomatosis, seborrheic keratosis, verrucous nevi and epidermolytic acanthoma. Although squamous papillomatosis of the vulva commonly involves the vestibule, we found a case report describing a case exactly similar to ours where the lesions were outside the vestibule (Mehta et al., 2009*).
Clinicopathological correlation is mandatory in diagnosing many skin diseases and clinicians should respect history given by the patients including duration of the lesions. Always put in your mind that verrucous lesions on the vulva are not necessarily condylomas!!!


*Mehta V, Durga L, Balachandran C and Rao L: Verrucous growth on the vulva. Indian Journal of Sexually Transmitted Diseases and AIDS 2009; 30(2): 125-126