Recurrent, nodular lesions over the vulva: A diagnostic challenge

Area of Science:

• Dermatology
• Vascular Tumors

Background:

• Angiokeratomas are benign vascular tumors with localized and widespread forms.
• Localized angiokeratomas include Fordyce, circumscriptum neviforme, circumscribed, and Mibelli types, with Fordyce's being most common.

Observation:

• A 38-year-old female presented with a 15-year history of asymptomatic, progressively enlarging dark, raised vulvar lesions.
• Examination revealed multiple pedunculated, hyperpigmented papules and nodular lesions with a verrucous surface on the labia majora and pubic area.
• No systemic comorbidities, family history, or oral/conjunctival/mucosal lesions were noted.

Findings:

• Histopathology confirmed marked dilatation of papillary dermal vessels, consistent with angiokeratoma.
• The lesions were successfully removed via radiofrequency ablation.

Implications:

• This case underscores the rarity of vulvar angiokeratoma.
• It emphasizes the critical need to differentiate nonvenereal genital lesions from sexually transmitted infections.