vulgaris. IgG directed against desmosomes...Figure 26.5 Pemphigus vulgaris: adjacent to a fresh blister (where epitheliu...Figure 26.6 Pemphigus vulgaris: marked oedema, erosions, and ulceration.
26 Chapter 27Figure 27.1 Nodular prurigo. Intensely pruritic nodules on lichen simplex.Figure 27.2 Intertrigo in right inguinal fold.Figure 27.3 Major oral aphthous ulcer.Figure 27.4 Healing aphthous ulcer lower‐right labium majus.Figure 27.5 Behcet’s disease. Deep scarring ulceration on vulva.Figure 27.6 Vulval amyloidosis: atrophy and architectural change.Figure 27.7 Histological features of plasma cell vulvitis showing marked epi...Figure 27.8 Plasma cell vulvitis, red/orange discoloration in vestibule.Figure 27.9 Adenosis after toxic epidermal necrolysis. Erythema and pigmenta...
27 Chapter 28Figure 28.1 Junctional type epidermolysis bullosa showing extensive erosion ...Figure 28.2 Hailey‐Hailey disease histology. Acantholysis showing ‘dilapidat...Figure 28.3 Hailey‐Hailey disease. Moist, scaly erythema and papules on vulv...Figure 28.4 Ligneous disease:deep amorphous hyaline material. Courtesy of Dr...Figure 28.5 (a) White sponge naevus of the vulva. (b) White sponge naevus wi...
28 Chapter 29Figure 29.1 Post‐inflammatory hyperpigmentation after lichen planus.Figure 29.2 Histological features of melanosis with increased basal melanin ...Figure 29.3 Vulval melanosis. Dark pigmentation upper vestibule.Figure 29.4 Melanosis showing irregular and variable macular pigmentation.Figure 29.5 Histology of Dowling‐Degos disease. The epidermis shows branchin...Figure 29.6 Dowling‐Degos disease. Speckled pigmentation on labia majora.Figure 29.7 Vitiligo showing symmetrical loss of pigment.Figure 29.8 Poliosis affecting right labium majus.
29 Chapter 30Figure 30.1 Vulval acne. Inflammation and pustule in right interlabial sulcu...Figure 30.2 Fox‐Fordyce disease. Papules seen in flexures.Figure 30.3 Lichen‐planopilaris. Lichenoid papules and hair loss on mons pub...
30 Chapter 31Figure 31.1 Initial lesion of fixed drug eruption on arm.Figure 31.2 Swelling and blistering on vulva.Figure 31.3 Fixed drug eruption to co‐trimoxazole showing acute erythema, sw...Figure 31.4 SJS/TEN syndrome. Multiple vulval ulcers and erosion.Figure 31.5 SJS/TEN syndrome. Widespread superficial erosions.Figure 31.6 (a) Persistent fixed ulcer secondary to nicorandil.Figure 31.7 Erosive change upper vestibule secondary to Foscarnet.
31 Chapter 32Figure 32.1 Glucagonoma syndrome: scaly and moist serpiginous rash.Figure 32.2 Acanthosis nigricans: velvety thickening on inner thighs.Figure 32.3 Crohn’s disease: fissures and erosions.Figure 32.4 Deep fissuring in gluteal cleft.Figure 32.5 Crohn’s disease: ulceration and scarring.Figure 32.6 Graft‐versus‐host disease: vulval synechiae and labial fusion.
32 Chapter 33Figure 33.1 Secondary genital lymphoedema. There is pitting oedema of the mo...Figure 33.2 Labial lymphoedema and lymphangiectasia secondary to cervical ca...Figure 33.3 Noonan syndrome causing bilateral lower limb and genital lymphoe...
33 Chapter 34Figure 34.1 Arteriovenous malformation of right labium majus.Figure 34.2 Vulval varicosities.Figure 34.3 Engorged varicosities in vestibule in a patient who also has lic...
34 Chapter 36Figure 36.1 Factors involved in aetiology of vulvodynia.Figure 36.2 Anatomic structures of the vulva with the most painful area mark...
35 Chapter 38Figure 38.1 Epidermoid cysts both labia majora. Several angiokeratomas are a...Figure 38.2 Mucinous cyst lined by a single layer of columnar endocervical‐t...Figure 38.3 Fibroepithelial polyp with mildly cellular stroma and overlying ...Figure 38.4 Seborrhoeic keratose showing stuck on waxy papules.Figure 38.5 Seborrhoeic keratosis composed of bland basaloid cells and kerat...Figure 38.6 Verruciform xanthoma with papillary proliferations.Figure 38.7 Hidradenoma papilliferum. Small nodule in right interlabial sulc...Figure 38.8 Hidradenoma papilliferum with variable sized tubular glands.Figure 38.9 Apocrine metaplasia in hidradenoma papilliferum.Figure 38.10 Syringomas. Flesh‐coloured papules on labia majora.Figure 38.11 Syringoma with cystic glands in dermis.Figure 38.12 Glands lined by double layer of cells with comma‐like tails.Figure 38.13 Vulval leiomyoma. Well‐circumscribed lesion with bundles of smo...Figure 38.14 Angiomyofibroblastoma showing myxoid stroma, numerous small blo...Figure 38.15 Cellular angiofibroma with rich vascular network and several sm...Figure 38.16 Histology of lymphangiectasia showing dilated vessels lined by ...Figure 38.17 Angiokeratomas. Multiple vascular lesions on right labium majus...Figure 38.18 Angiokeratoma. Dilated vascular channels with hyperkeratosis of...
36 Chapter 39Figure 39.1 Atypical genital naevus. Irregular dark naevus on right labium m...Figure 39.2 Histological features of atypical genital naevus with nest of me...
37 Chapter 40Figure 40.1 (a) High‐grade squamous intraepithelial lesions (HSIL) histologi...Figure 40.2 HSIL. Positive high‐risk HPV.Figure 40.3 HSIL. Positive Ki‐67.Figure 40.4 HSIL. Polymorphic lesions with multiple warty lesions and some e...Figure 40.5 Extensive HSIL with hyperkeratotic area extending into vagina.Figure 40.6 Anal intraepithelial neoplasiaFigure 40.7 Pigmented HSIL. Lesions resembling seborrheic keratoses.
38 Chapter 41Figure 41.1 Differentiated VIN, thickened epidermis, and abnormal keratinocy...Figure 41.2 Differentiated VIN‐positive p53 staining in basal layers.Figure 41.3 (a) Differentiated VIN. Ulcerated with hyperkeratotic edge right...Figure 41.4 Small squamous cell carcinoma (SCC) arising in dVIN (glazed eryt...Figure 41.5 Differentiated VIN with invasive small squamous cell carcinoma (...
39 Chapter 42Figure 42.1 Non‐invasive vulval Paget’s disease, with typical clusters of Pa...Figure 42.2 Vulval Paget’s disease: erythema with erosions and areas of hype...Figure 42.3 Peri‐anal Paget’s diseaseFigure 42.4 Vulval Paget’s disease of the interlabial sulcus and right inner...
40 Chapter 43Figure 43.1 Overview of the multistage evolution of vulval squamous cell car...Figure 43.2 (a) Vulvar squamous cell carcinoma (VSCC) on the background of l...Figure 43.3 Invasive squamous cell carcinoma (SCC) arising from a plaque of ...Figure 43.4 Moderately differentiated large‐cell keratinising carcinoma with...Figure 43.5 Low magnification of early invasive squamous carcinoma with push...Figure 43.6 Verrucous carcinoma with extensive warty vulval plaque.Figure 43.7 (a) A 55‐year‐old patient developed on the background of multifo...Figure 43.8 Examples of fasciocutaneous flaps that may be used for perineo‐v...
41 Chapter 44Figure 44.1 Ulcerated nodular melanoma.Figure 44.2 In situ melanoma histological features with cytological atypia....Figure 44.3 Vulval melanoma with irregular pigmentation and nodular areas.Figure 44.4 Extensive nodular malignant melanoma with amelanotic areas.Figure 44.5 In situ melanoma with very subtle pigmentation affecting glans c...
42 Chapter 45Figure 45.1 Vulval basal cell carcinoma. Pearly nodule on right labium majus...Figure 45.2 Superficial basal cell carcinoma with peripheral palisading aris...Figure 45.3 Morphoeic basal cell carcinoma with infiltrating tumour cords.Figure 45.4a Dermatofibrosarcoma protruberans with extensive replacement of ...Figure 45.4b Dermatofibrosarcoma protruberans. Lace‐like infiltration of the...Figure 45.5 Aggressive angiomyxoma. Hypocellular myxoid lesion in the subcut...Figure 45.6 Aggressive angiomyxoma. Replacement of the fat, and few bland, s...Figure 45.7 Vulval epithelioid sarcoma. Sheets of tumour cells often without...Figure 45.8 Vulval epithelioid sarcoma. Large, pleomorphic epithelioid cells...Figure 45.9 Adenoid cystic carcinoma composed of infiltrating nests punctuat...Figure 45.10 Adenoid cystic carcinoma composed of anastomosing trabeculae wi...Figure 45.11 Merkel cell carcinoma. Proliferation of small cells below the s...Figure 45.12 Merkel cell carcinoma. Ill‐defined cords of small cells with sc...Figure 45.13 Primary marginal zone lymphoma of the vulva. Nodule left labium...
43 Chapter 46Figure 46.1 Types of female genital mutilation.Figure 46.2 The surgery step by step: 1. Removing the scar tissue. 2. Dissec...Figure 46.3 Clitoral reconstruction immediately post‐operatively.Figure 46.4 Clitoral reconstruction 6 months post‐operatively.
44 Chapter 49Figure 49.1 Irritant eczema affecting convex labia majora.Figure 49.2 Extensive psoriasis with maceration in inguinal folds and fissur...Figure 49.3 Prepubertal lichen sclerosus, symmetrical pallor with haemorrhag...Figure 49.4 Lichen sclerosus with marked ecchymosis.Figure 49.5 Lichen sclerosus with hyperkeratosis and some oedema.Figure 49.6 Vulval vitiligo.Figure 49.7 Lichen sclerosus and vitiligo occurring together.Figure 49.8 Linear IgA disease – clustered bullae of the lower abdomen and g...Figure 49.9 Acrodermatitis enteropathica with bright red erythema.
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