Vulvar punch biopsy for evaluating vulvar dermatoses in primary care: Procedural guide

To provide family physicians with a step-by-step guide to performing vulvar punch biopsy (VPB) for the evaluation of vulvar dermatoses in primary care, including guidance on diagnosis, initial management, and indications for specialist referral.

A comprehensive literature search was performed in PubMed, Google Scholar, and Omni using a combination of Medical Subject Headings and free-text terms, including vulva or vulvar and biopsy or punch biopsy and dermatology or dermatosis or lesion of disease. The search was limited to English-language articles published between 1994 and 2024 on human participants. Articles were included if they addressed indications, technique, diagnostic utility, or clinical application of VPB, particularly in primary care or outpatient settings.

Vulvar concerns are common in primary care and may indicate various conditions, ranging from benign dermatoses to premalignant or malignant lesions. When left untreated, these conditions can lead to complications including anatomical changes, malignant transformation, sexual dysfunction, and decreased quality of life. Histologic diagnosis of dermatoses, such as psoriasis or lichen planus, permits earlier treatment of symptoms and may help prevent long-term consequences. Punch biopsy is a simple, office-based procedure within the scope of family physicians, but it is underused for the evaluation of vulvar conditions. This article outlines VPB as an office-based diagnostic tool for vulvar dermatoses, including indications and contraindications, procedural steps, complications, postprocedural care, and common pitfalls. A video demonstrating how to perform a vulva punch biopsy, including necessary preparations and indications is available from https://youtu.be/qdHbepcLRhg.

VPB is a safe and effective diagnostic tool for evaluating vulvar dermatoses that family physicians can perform to improve timely diagnosis, initiate management, and facilitate specialist referral when needed, ultimately enhancing patient care and outcomes.