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EV362/#376  Genital dermoscopy – a useful non-invasive adjunct in the diagnosis of Vulvar Intraepithelial Neoplasia
  1. Ieera Aggarwal,
  2. Wang Junjie,
  3. Qiu Ju Ng and
  4. Rama Namudri
  1. KK Women’s and Children Hospital, Gynaecological Oncology, Singapore, Singapore

Abstract

Introduction Vulvar Intraepithelial Neoplasia (VIN) is a pre-malignant condition with a risk of progression to squamous cell carcinoma of the vulva. VIN can be categorized into HPV-related and differentiated VIN. HPV-related or usual VIN presens as warty lesions, pigmented, white or erythematous plaques, or ulcers. Dermoscopy offers a rapid, non-invasive tool to study the epidermal and dermal features, aiding in the diagnosis. We describe the use of dermoscopy in HPV-related Vulvar Intraepithelial Neoplasia (VIN), correlation of dermoscopic features with histopathology and differentiation from genital warts.

Methods This study was conducted at the multidisciplinary vulva clinic at KK Women’s and Children’s Hospital, Singapore. Genital mucosal lesions were examined using the handheld Dermlite DL5 hybrid dermatoscope with 365nm UV, providing 10x magnification. Dermoscopic images were directly recorded by attaching it to an iPhone 11 Pro Max using the magnetic connect Clamp. The genital lesions were covered with a transparent sheet, and snap-on disposable IceCaps to maintain infection control and prevent cross-contamination during contact dermoscopy. Both polarized and non-polarized modes were utilized to capture various dermoscopic features of the genital lesions. Ethical approval from the Institutional Review Board and written informed consent from the patients was obtained for this prospective study.

Results Dermoscopy revealed distinct features in HPV-related VIN, including pigmented plaques with a white veil, papillomatous lesions with polymorphic vascular structures such as the dotted and glomerular vessels, hyperkeratotic scales within the plaque and areas of erythema and pigmentation.

Conclusion/Implications Dermoscopy is a useful, non-invasive adjunct in distinguishing VIN from other vulvar conditions, such as genital warts.

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