Benign and Malignant Tumors
This is a benign tumor of the eccrine sweat glands and ducts that tends to occur in young women. The cause remains unknown, but there are reported series of familial cases [1].
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David Nunns and Rosalind Simpson
14.1 Syringoma This is a benign tumor of the eccrine sweat glands and ducts that tends to occur in young women. The cause remains unknown, but there are reported series of familial cases [1]. Histologically the features include dilated ductal structures with characteristic “comma- like” tails within a sclerotic dermis. The nests have a characteristic tadpole-like morphology. They are common on the face but uncommon on the vulva where they can be associated with pruritus. On the vulva they usually occur on the labia majora as multiple, confluent white or skin- colored papules, usually 1–4 mm diameter, but they may measure up to 2 cm (Fig. 14.1). Patients may also have synchronous lesions elsewhere. A biopsy can usually confirm the diagnosis. As these are benign skin tumors, a conservative approach is possible with symptomatic management of any associated pruritus. Symptomatic
D. Nunns (*) Department of Gynaecological Oncology, Nottingham University Hospital, Nottingham, UK R. Simpson Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK e-mail: [email protected]
Fig. 14.1 Syringoma. Patient complains of intense pruritus. The labia majora contains multiple, confluent skin- colored papules. Courtesy of Professor Jacob Bornstein
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_14
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patients may be treated with CO2 laser treatment as an alternative [2].
14.2 Basal Cell Carcinoma Basal cell carcinomas (BCC) are the commonest skin cancer on non-vulval skin, but on the vulva they are less common and account for only 5% of vulval skin cancers. They tend to occur in women with average age at diagnosis being 70 years [3]. BCC usually present with a solitary vulval nodule, papule, or ulcer on the labia majora and rarely affect the mucosal surfaces [4]. They are usually around 1–2 cm in diameter but can vary in size from a few mm to several cm giving rise to symptoms of pain or itch. Bleeding occurs if the tumor is ulcerated. Histological features are the same as those seen elsewhere and classically include proliferation of nests of small basal cells with high nuclear-to-cytoplasmic ratio, peripheral palisading, mitotic figures, apoptosis, and retraction artifact. A wide variety of histologic types have been described including the following patterns: nodular, infiltrating, and morpheaform [3]. The presence of perineural invasion can predict local recurrence. The cause remains unknown, but chronic irritation, immunosuppression, and genetic predisposition have been suggested. Sun exposure is a risk factor for non-vulvar areas, but this is not believed to be a risk for vulvar disease. Diagnosis is usually made by an incisional biopsy rather than excision a piece of the lesion for biopsy. Incisional biopsies can enable accurate surgical planning once the diagnosis is confirmed. In principle diagnostic excisional
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