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how to diagnose and differentiate vulvar melanoma-vulvar melanoma is easy to confuse diseases

how to diagnose and differentiate vulvar melanoma-vulvar melanoma is easy to confuse diseases

Differentiation of vulvar melanoma

Pigmented skin lesions of vulva are very common and often not noticed by patients. Usually these lesions are benign lesions, which are easily confused with vulvar melanoma and need to be distinguished from these common lesions. Common benign pigmentation lesions of vulva have simple stains, vulvar melanosis, various nevus, acanthosis nigricans and seborrheic keratosis. Vulvar malignant tumors, such as intraepithelial neoplasia, squamous cell carcinoma, basal cell carcinoma and vulvar Paget's disease, also have the characteristics of pigmentation changes. Because of the diversity of melanoma tissue structure, epithelioid cells in melanoma cells should be distinguished from squamous cell carcinoma and adenocarcinoma under light microscope, spindle cells should be distinguished from leiomyosarcoma and sometimes malignant mesodermal leaves (including choriocarcinoma). Finding pigment granules in cells and tissues is helpful for diagnosis.

1. Nevus vulvae

Nevus grows slowly, local lesions are stable, and the surface is higher than the skin, which can be distinguished under light microscope. If the pigmentation range of nevus is expanded, the pigment is deepened, and there is ulcer bleeding on the surface, especially the nevus on the skin with hair in vulva, it should be highly suspected that it is the malignant transformation of nevus.

2. Urethral caruncle

Melanoma around urethral orifice is easily misdiagnosed as urethral caruncle, which is reddish or crimson, with clear boundary, smooth surface, slow growth, soft quality and no obvious pigmentation. Careful physical examination combined with pathological changes is easy to identify.

3. Basal cell carcinoma of vulva

It is more common in elderly women, especially in the front of labia majora. The tumor grows slowly, often accompanied by bleeding and ulcer formation. The tumor is hard, the boundary is clear, the surface is rough and granular, which can be black. Pigmentation is generally around the focus, which must be differentiated from melanoma.

4. Vulvar Paget disease

Most of them occur in postmenopausal women, and the lesions are mostly located in labia majora and perianal region, with eczema-like changes, which can form shallow ulcers and scabs with clear boundaries. Microscopically, Paget cells infiltrated and melanocytes swallowed melanin were also seen. It is often confused with superficial melanoma, and can be distinguished by immunohistochemical staining.

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