IJWD Image Quiz Challenge

Images in Women's Dermatology Quiz

What is your diagnosis?


A 72-year-old female Indian patient presented with a right labial hyperpigmented plaque, which was intensely pruritic after urination. The plaque initially appeared as a small papule and grew to approximately 2 cm over the course of 2 months (Fig. 1). No other vulvovaginal abnormalities were present. The patient was also diagnosed with lichen simplex chronicus on the left side of the neck, which was well controlled with moisturizer and betamethasone dipropionate 0.05%. No oral lesions were present. She had undergone hysterectomy due to uterine fibroids. However, there was no history of immunosuppressive or radiation therapy. The patient also denied any ultraviolet exposure to the area. A strong family history of colon cancer was significant in her siblings. The skin biopsy from the vulvar lesion showed irregular basaloid lobules forming bulb-like structures with increased melanocytes, as well as abundant melanophages within a loose mucinous stroma. Immunoperoxidase stains indicated that the tumor was strongly positive for BerEP4, CK7, CK17, CAM5.2, and CK5 and 6.