There are limited data specific to vulvovaginal melanomas, especially regarding systemic therapies. If you think that you may be at elevated risk to develop ovarian cancer, bring these factors to the attention of your personal physician. AJ. Melanocytic nevi commonly form during early childhood and occur as a response to sun (ultraviolet) exposure. The vulva refers to the external female genitalia, which include the labia, the opening of the vagina, the clitoris, and the space between the vagina and the anus. bleeding not associated with menstruation. Vulval cancer. arrow-right-small-blue A member of the WVFC Medical Advisory Board, Dr. Elizabeth Poynor is a practicing gynecologic oncologist and pelvic surgeon, with a Ph.D. in cell biology and genetics. RI. The clinical features of vulvar melanoses can overlap with those of melanoma.16-18 They can be asymmetric and unilateral with an intense and even nonhomogeneous pigmentation that is either focal or diffuse. The dermoscopic features were photographed using Dermaphot (Heine Optotechnick), which connects the dermatoscope to the camera to generate reproducible, high-quality dermoscopic images at 10-fold magnification in JPEG format. Genital skin is delicate, so treatment must be undertaken gently. These colors were mixed to varying degrees within the same lesions. C, Atypical melanocytic lesion in which the presence of white and blue colors inside the lesion was detected dermoscopically in addition to classic globules and streaks on the periphery. Such surgery can improve function and appearance. I believe most women have no idea they cancer get cancer down there. Design, Setting, and Participants , Venkatesan DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. I was diagnosed in 2008 with stage III malignant melanoma of the vulva. Some medical sources also claim that vulvar melanosis can fade following childbirth but the inevitability is not yet clear. L Rogers and M CuelloInternational Journal of Gynaecology and Obstetrics, 2018. Alternatively, an excisional vulvar biopsy may be recommended to completely get rid of the darkened small area. You play a large role in your own health. This mark never bothered me, never any pain or anything suspect. Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. Vulvar genital melanosis. Preserved rete ridges, vacuolar basal alterations with a thickened basement membrane, and a homogenized papillary dermis are features associated with lichen sclerosus.4,13 Crowded and disordered arrays of melanocytes with nuclear hyperchromasia and atypia, thick dendrites, pagetoid spread, and a variable subepithelial inflammatory infiltrate are associated with a diagnosis of melanoma.14,15. DF. Some of the tests that were done to diagnose vulvar cancer or determine the stage may be repeated. Author Contributions: Dr De Giorgi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Furthermore, the vascular pattern was difficult to characterize and could not be assessed because of the specific anatomy of the site, which highlighted a large number of vascular structures on the entire vulvar mucosa (Table 1). Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits. The data collected in the database included the characteristics of the patients (eg, age, menopause status, and hormone use) in addition to the clinical and dermoscopic features of the vulvar lesions. Can you comment on the sudden appearance of multiple, 1-2 hyper pigmented lesions on bilateral labia majora in a 47 year old white female.There are clusters of 3-4, with one 3-4mm papule. Skin lesions are mainly typical of those found elsewhere on the body, and are found on the outer aspects of the vulva, the labia majora, extending to the groin. This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. Melanosis of the vagina and human papillomavirus infection, an uncommon pathology: case report. You may continue to be tested at various time points after treatment has ended to see if your condition has changed and to make sure that the cancer has not returned. Topics AZ They may know of a trial that is running in your hospital or another specialist hospital. Postmenopausal skin and estrogen. Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. Learn how to reduce burdens with health tech. Concept and design: De Giorgi, Gori, Massi. All Rights Reserved. Invite your family to do the same. A total of 10% of cases (13 of 129) presented a nonspecific pattern owing to the absence of well-defined or recognizable dermoscopic features. C, Histopathologic examination reveals epidermal acanthosis and increased pigmentation of the basal keratinocytes. Clinical Dermoscopic and Pathologic Aspects of Vulvar Melanosis in a Woman in Her 50s, Figure 2. Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of your vagina; Vaginal sarcoma, which develops in the connective tissue cells or muscles cells in the walls of your vagina; Risk factors. Because these areas are not sun-exposed, it is not generally recognized by women that melanoma can develop in this location. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years). They have structure less and parallel pattern in vulva location. Dermoscopic features of mucosal melanosis. Melanoma is usually treated with surgical excision and evaluation of the regional lymph nodes. Bleeding in the vulvar area not related to. The earlier a cancer is discovered and treated, the better the chance of a positive, long-term outcome. Other benign pigmented lesions include lentigines, also known as freckles; melanosis, the accumulation of pigment deposits;post-inflammatory hyperpigmentation, a collection of pigment in reaction to trauma and other skin conditions; seborrheic keratosis; hemangiomas; and warts. This vulva condition is characterized by the distribution of brown to black pigmentations that are multiple, flat distinct and stable. During surgery, doctors then check for lymph nodes that look blue or green or that give off a radioactive signal . Approximately 3 percent of all melanomas are located in the genital tract. For vulvar cancers, there are 3 main types of treatment. In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Mucosal melanomas are most often found in the head and neck, in the eyes . document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); I had a melanoma on my leg five years ago. , Barnhill Vulvar melanosis and lentiginosis affects all age groups but favors perimenopausal women. Lastly, complications may spring from the underlying genetic syndrome explained above. , Fung If surgery is part of your treatment, your body may look different afterward. Vulvar melanosis is black and/or various shades of brown, whereas the combination of red, blue, or gray colors in the lesion should be viewed with suspicion and necessitate a biopsy. B, Dermoscopic examination revealed irregular diffuse pigmentation characterized by the presence of brown and black colors in the absence of other dermoscopic parameters. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The Academy has developed quality measures to help your dermatology practice. DS. Mucous membranes are moist surfaces that line cavities within the body. Remember melanosis is harmless but you may assume this is the case yet other serious conditions like melanoma may be the real disorder. 2020;156(11):11851191. Is there something else it could be? Dermoscopic Features in 129 Cases of Melanosis, Table 2. Drafting of the manuscript: De Giorgi, Gori, Salvati, Scarf, Maida, Silvestri, Venturi, Massi. Medical studies are still underway to unveil more theory about this vulvar condition. Im not happy with that, I want it looked at. A partial vulvectomy (surgery to remove the tumor and a rim of healthy tissue around it), along with lymph node removal is the usual treatment for melanoma on the vulva. Three investigators (V.D.G., F. Scarfi, and A.G.) with expertise in pigmented lesions and dermoscopy and no knowledge of the clinical history of the lesions independently analyzed the archived digital dermoscopic images and completed a printed questionnaire to categorize the lesions according to typical dermoscopic pattern analysis. The groin is also a favoured site for some parasitic infestations: Important sexually transmitted infections (STIs) include: Non-infectious skin lesions and miscellaneous conditions that are commonly found in the genital area include: A careful history and full skin examination, including genital skin, are recommended. It was indeed another melanoma, once again, caught early. Vulvar cancer may not cause noticeable early symptoms. Look for any moles, spots, lesions, bumps, or rashes. Types of vaginal melanoma. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years). RL, Albert Though many medical studies say there is no treatment applicable for vulvar melanosis, there are some producers that can be considered as treatment in my opinion. This is due to the fact that pigmented lesions in vulva may have almost similar symptoms. More research needs to be done to determine what causes specific types of skin cancer to form. De Giorgi V, Gori A, Salvati L, et al. The intradermal nevus arises within the dermis (Fig. Read this month's top stories in Dermatology World. The mean age of diagnosis was 46 years (range, 19-83 years), and 67% of lesions appeared in patients younger than 50 years, which suggests that hormonal status may have a role to play in the etiopathogenesis of vulvar melanosis. Recommended Reading: What Is Stage 2 Squamous Cell Carcinoma. Histopathological characteristics of malignant melanoma affecting mucous membranes: a unifying concept of histogenesis. What causes vulva melanosis? A ringlike pattern (Figure 2B) was found in 19 cases (15%). The doctor may opt to examine the benign vulvar lesion for some time but when the successful diagnosis of melanotic macule is done, I mean when vulva melanosis is discovered, no treatment will be literally required. Venkatesan A. Pigmented lesions of the vulva. Although the small number of patients in our series does not allow us to draw definitive conclusions, this association is further supported by the absence of reports of vulvar melanosis before menarche, both in the present study and in the literature. An incisional biopsy site was chosen based on the most clinically significant areas. It includes: Labia majora: two large, fleshy lips, or folds, of skin. M. , Ferrari Vulvar tumors typically look like any of the following, including a cauliflower-like wart, red or pink bump, or lightened or darkened skin. The evolution of melanoma diagnosis: 25 years beyond the ABCDs. I have never been diagnosed with HPV or had an abnormal pap result. Researchers have proposed associations between vulvar melanosis and hormonal changes, lichen sclerosus, or human papillomavirus infection.2,4-6, The diagnosis relies on clinical, dermoscopic, and histopathologic examination. The color of the lesion was also recorded. 2010;28:795-805. If you get too much exposure to UV radiation, it can damage the DNA of your skin cells. , Rudolph But sometimes doctors can instead do a sentinel lymph node What Is a Sentinel Lymph Node? K. Read Also: Stage 4 Basal Cell Carcinoma Life Expectancy. Again, look for rashes, bumps, growths, and lesions. All content found on Dermatology World Insights and Inquiries, including: text, images, video, audio, or other formats, were created for informational purposes only. All in one place. Critical revision of the manuscript for important intellectual content: De Giorgi, Gori, Salvati, Trane, Portelli, Covarelli, Massi. Thin vulvar melanoma: a challenging diagnosis: dermoscopic features of a case series. This is not a harmful condition, you remember? For pre-cancers (vulvar intraepithelial neoplasia or VIN), topical treatments can be used. My gynecologist knew about my history. Vulvar melanoma is rare, but it does occur AND NOT only to elderly women. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2020;156(11):1185-1191. doi:10.1001/jamadermatol.2020.2528. Synopsis Genital melanosis and lentiginosis is a benign condition that is characterized by irregular pigmentation on the genital mucosa. Patients typically complete yearly follow-up visits after their initial diagnoses. First, our data are from a single center, potentially limiting the generalizability of our results. Improving mortality and survivalwith this potentially lethal diseasedepends on early recognition, and experience counts. In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. The dermoscopic pattern and the presence or absence of dermoscopic features in a given lesion were defined by the agreement of at least 2 of the 3 dermoscopists. The stress can emerge more skin conditions that can be very severe than melanosis. A biopsy specimen shows only marked lower epidermal pigmentation without any melanocytic atypia or nesting. If you bear such risks, it is not a guarantee that you`ll suffer vulva melanosis. These changes may make you feel different or less attractive. The Azienda Toscana Centro institutional review board approved this retrospective study. Melanoma of the vulva accounts for 5 to 7 percent of invasive vulvar cancers and has an estimated annual incident rate of 1 per 1 million women. By continuing to use our site, or clicking "Continue," you are agreeing to our, Figure 1. AF, Rock Published Online: August 12, 2020. doi:10.1001/jamadermatol.2020.2528. D, Immunohistochemical staining with antityrosinase antibody highlights a slight increase in basal and suprabasal melanocytes with no cytologic atypia (tyrosinase, original magnification 20). I asked her if I should have a small, flat mole, that was skin colored but new, removed from the area between my vagina and the anal area. Some of the rare genetic disorders associated with this condition include the following: When numerous melanosis is diagnosed in one area, genetic syndromes are usually blamed however, when they are isolated, usually, no associated condition is discovered. Most vulvar melanomas are dark brown or black, but they can also be white, pink, red, or other colors, according to. Normally, melanosis does not have a substantial melanocytic proliferation, nesting pattern of melanocytes, or melanocyte atypia. , To register for email alerts, access free PDF, and more, Get unlimited access and a printable PDF ($40.00), 2023 American Medical Association. There is no downside to being cautious and careful when it comes to your health. A skin biopsy is required when clinical diagnosis is inadequate or when malignancy is suspected. Factors that may increase your risk of vaginal cancer include: Increasing age. with expertise in melanocytic lesions to confirm the diagnosis and evaluate the dermoscopic-histopathologic associations. Blue and gray colors were recorded in only 9 cases (7%) (Table 2). We will probably not hear anything back for several days. All Rights Reserved. Detection and Diagnosis Finding cancer early -- when it's small and before it has spread -- often allows for more treatment options. Main Outcomes and Measures Acquisition, analysis, or interpretation of data: De Giorgi, Salvati, Scarf, Maida, Trane, Silvestri, Portelli, Venturi, Covarelli, Massi. MA, Rhodes A woman should note any change in appearance in her vulvar skin, or pain or itching, to her physician. Treating Vulvar Cancer Treatment of Vulvar Melanoma Vulvar melanoma starts on the skin of the vulva. This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. 2023 American Medical Association. But remember vulvar melanoma is a different thing altogether. CS, Pomeranz Meaning The International Rare Cancers Initiative aims to develop more research into new treatments for rare cancers. Let them support you during this time. Melanosis of the vulva: a clinical simulator of malignant melanoma. Around the opening of the vagina, there are 2 sets of skin folds. Malignant melanoma on the vulva (VC-patient2) Irregularly marginated and pigmented lesion on the vulva and crural fold - a superficial spreading malignant melanoma. Check out DermWorld Insights & Inquiries for the latest updates from Dr. Warren Heymann. Proper diagnosis should be done to be sure whether it is vulvar melanosis or vulvar melanoma. MJ. Vaginal mucosal melanoma can be found anywhere in this part of the body, but is usually found in the vaginal wall in the lower third of the vagina. There are four main stages: If youve been diagnosed with a certain stage of cancer, ask your healthcare provider to explain the details of the specific stage and what it means. Higher five-year survival rates are seen in earlier stage disease compared with late stage disease . And when you see changes, make an appointment to see your healthcare provider. On the other hand, lacking the risk factors doesn`t imply that you wont get melanosis. In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. Even new features that have been described by various dermatologic schools, such as the ringlike pattern that was found in only 15% of the patients in the present study, are not a reliable and accurate diagnostic dermoscopic clue. If cancer is found, youll undergo other tests to find out if the cancer has spread to other areas of the vulva or your body. F, Cattaneo Genital skin problems are very common and can be very itchy or painful, distressing and embarrassing. Are there other things that look like this? These are Genetic disorders and Lichen sclerosis. They dont change the thickness of the skin. , Sison-Torre Nevi are classified as intradermal, junctional, and compound. Your GP will be required to do persistent follow-up together with regular screening and check-ups to monitor or to prevent other possible problems such as secondary infections after biopsies. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The clinical history of the lesions, the results of dermoscopic examinations, and the histopathologic features of the melanosis were evaluated. D, Carli Both the clinical and dermoscopic features of all of the lesions were photographed using a high-resolution compact digital camera (Olympus Digital model No. Because of its inconspicuous location, patients may not be aware of the presence of vulvar melanosis, and an adequate medical history is very difficult to achieve for physicians. Genital melanosis, also known as vulvar lentiginosis and vulvar melanotic macules, is a benign lesion characterized by macular pigmentation that can involve cutaneous or mucosal sites. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); Ovarian cancer is not common, but it can be lethal. Pigmented Lesions of the Vulva Yes, You Can Get Melanoma Down There!. This means that mucosal melanoma can be found in the respiratory tract, gastrointestinal tract or genitourinary tract. I was born with what I thought was some sort of beauty mark or very slightly pigmented freckle on my labia. Check your labia majora and feel for any bumps. The other good news is that your doctor performed a careful exam and removed something that did not look normal. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. Vulvar melanoma. Learn how your comment data is processed. , Saida Why Negotiation Skills Are Important in Health and Social Care? You May Like: Melanoma Bone Cancer Life Expectancy. Your risk of vaginal cancer increases as you age. When it comes to size, the size of various types of melanosis often varies although the general range tends to be between 1 -15 millimeters in diameter. They are designing trials that involve several countries so that more people will be available to enter trials. Explore hundreds of Dermatology World Insights and Inquiries articles by clinical area, specific condition, or medical journal source. Cases in young girls should prompt physicians to check for multisystem genodermatoses, such as Peutz-Jeghers syndrome, Carney complex, Noonan syndrome with multiple lentigines, Bannayan-Riley-Ruvalcaba syndrome, and Dowling-Degos disease, which can be associated with genital melanoses.3, The etiopathogenesis of vulvar melanosis is poorly understood. Once a biopsy has been performed on a lesion and a histopathological diagnosis has been made, strong consideration should be given to the possibility of consultation with a board-certified dermatopathologist, a pathologist witha special expertise with pathology of the skin. et al. document.getElementById( "ak_js_3" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. , Cario Portable Shattaf: The Convenient Solution for Personal Hygiene on the Go, Myths and Facts Concerning Obstructive Sleep Apnoea, Wisdom Tooth Extraction Recovery: Dos And Donts For A Smooth Healing Process. Vulvar Cancer Early Detection, Diagnosis, and Staging Know the signs and symptoms of vulvar cancer. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. A, Clinical examination reveals a multifocal pigmented lesion with nonhomogeneous pigmentation with partially clear and partially blurred margins. The vulva is the external portion of the female genital organs. Director of Gynecologic Oncology Amanda Fader and oncology dietitian Mary-Eve Brown discuss the correlation between the two. Pigmented vulvar lesions. Vulvar melanosis is characterized by asymmetrical, tan-brown to black, irregularly bordered macules of variable size on the vulvar mucosa. Also Check: What Is The Survival Rate For Invasive Ductal Carcinoma. The symptoms of vulvar cancer may look like other conditions or medical problems. This can be present in many locations of vulvar including the periureteral area. Customize your JAMA Network experience by selecting one or more topics from the list below. Vulvar melanoma usually occurs on the labia minora or the clitoris; signs of vulvar melanoma can include a black or brown raised area or a change in the size, shape, or color of a pre-existing mole. P. Melanoma of the vulva has a poorer prognosis overall than melanoma on the torso, most likely because of the extent of the disease at the time of diagnosis. , Rigel When an individual notice the ugly longstanding dark spots, they may be emotionally stressed and even develop cosmetic concerns. D, Melanosis in which black and various shades of brown colors were observed dermoscopically in the absence of other colors or other dermoscopic parameters. Histopathologic slides were reviewed by a dermatopathologist (D.M.) Proliferative lesions affecting the vulva may originate from skin, mucosa or underlying connective tissue. J, Delgado O, Argenziano Dermoscopically, these colors correspond to superficial structures, which correspond to the histopathologic condition of melanosis that is characterized by hyperpigmentation of basal keratinocytes. This can lead to mutations in the DNA, causing the cells to grow out of control. Labia minora: small lips just inside the labia majora surrounding the openings to the urethra and vagina. Lynn Kowalski, MD Gynecologic Oncologist, Does Amelanotic Melanoma Blanch When Pressed, What Does Cancer Look Like Outside The Body, What Is a Sentinel Lymph Node? If you have any suggestions and queries you can contact us on the below details. Genital lentigines and melanocytic nevi with superimposed lichen sclerosus: a diagnostic challenge. In such cases, the treatment for genetic disorders may be applied. There is no well-defined entity regarding the symptoms. Non-venereal skin infections may present in the genital area, presumably because the organisms thrive in warmth and humidity. The lesions on the posterior fourchette are dark brown to black in color while other superior macules in the labia minora and vagina are lighter brown. Topical Therapy for Vulvar Pre-Cancer. Lesions such as moles and frecklesreferred to as pigmented lesionsoccur on the vulva of 10 percent to 12 percent of women. An association between hormonal status and vulvar melanosis may be hypothesized. Scientists dont know exactly why DNA mutations to the melanocyte cells sometimes cause nodular melanoma and not other melanomas. Importance Its been nearly 20 years since Queensland woman Pam was diagnosed with vulval cancer, but she still remembers the day clearly. Since some vulvar cancer is a type of skin cancer, the American Cancer Society also recommends self-examination of the vulva using a mirror. Here the common clinical symptom of vulvar melanosis: Vulvar melanosis is a vulva skin condition that is not infectious and s cannot spread from one person to another during sex, you should not panic about that. Privacy Policy| et al. Dermatology Made Easybook. E-520, a 7.1-megapixel digital photographic camera with a 3.8 optical zoom lens, a focal length of 28-105 mm in a 35-mm format, and a maximum lens aperture of f/2.8-f/5.8; Olympus America Inc). 2023 American Medical Association. Women's Voices for Change 2023 - All Rights Reserved - Terms and Conditions - Privacy Policy. G, Getting enough patients is critical to the success of a trial. The equipment used for the dermoscopic examination consisted of a handheld dermatoscope (Heine Delta 20, Heine Optotechnick). Our experience suggests that vulvar melanosis has a benign clinical course. Approximately 30% of lesions increased in size and/or changed pigmentation and then stabilized after about 18 months without malignant evolution. G, Rivas I was very lucky to find a wonderful gynecologist oncologist who saved my life. But any ovarian cyst should be taken seriously. For 37 patients (29%) who were younger than 50 years, a slow increase in size was recorded over a mean period of approximately 18 months (range, 14-23 months), followed by stabilization of the lesion. Ovarian Cancer: What Is It, and Am I at Elevated Risk? A and B, The presence of very similar pigmented lesions makes it difficult to diagnose atypical melanocytic lesion (A) or melanosis (B) with the naked eye. Scattered melanophages are observed in the superficial dermis (hematoxylin-eosin, original magnification 20). These clinical and dermoscopic images were stored on a Microsoft Windows (Microsoft Corp)based personal computer. There are randomly dispersed single basal melanocytes with nuclear hyperchromasia without significant atypia or nest formation and interspersed melanophages below the epidermis (hematoxylin-eosin, original magnification 5 [C] and 20 [D]). It is hard to organise and run trials for rare cancers. This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. These tests may include: Additional internal scope exams may be ordered, including. Always consult a doctor for diagnosis. However, genetic factors are also in the development of some types of melanocytic nevi. Vulvar nevi, melanosis, and melanoma: an epidemiologic, clinical, and histopathologic review. If yes, what are the treatments? Doctors may remove a sentinel lymph nodes on one or both sides of the vulva, depending on the size of the tumor. 9 . Note that this may not provide an exact translation in all languages, Home L. Vulvar and vaginal pigmented areas are often benign, part of a process of melanin deposition in the genital tissue, sometimes referred to as melanosis. Also Check: Life Expectancy Metastatic Melanoma. The doctor said to me, That looks a bit weird, youve got a lesion down there. This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. That can cause much stress for you and your loved ones. Estrogens and aging skin. It is sometimes located in the vulva region, and can very rarely involve the cervix. Our discussion forum Cancer Chat is a place for anyone affected by cancer. EC, Penn These dermatologists possessed identical levels of training and experience in dermatology, each with more than 5 years of practice in dermoscopy. Learn what you can do to reduce your risk. Light microscopic criteria for the diagnosis of early vulvar lichen sclerosus: a comparison with lichen planus.