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Contempo Updates |

Update on Genital Lesions

Ted Rosen, MD
JAMA. 2003;290(8):1001-1005. doi:10.1001/jama.290.8.1001.
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The appearance of an external genital lesion may engender considerable anxiety in a patient. From the medical professional perspective, genital lesions pose serious diagnostic and therapeutic challenges. Genital skin can erode or ulcerate, develop dyschromia (hyperpigmentation or hypopigmentation) or erythema, and either thicken or atrophy in discrete or generalized fashions. However, genital lesions may result from many etiologies including sexually transmitted diseases (STDs), non-STD infectious agents, inflammatory cutaneous disorders, multisystem diseases, benign and malignant neoplasms, and exogenous (external) factors (Table 1).1

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Figure 1. White Macules of Lichen Sclerosus et Atrophicus and Vitiligo
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A, Lichen sclerosus et atrophicus has premalignant potential. B, Vitiligo appears similar to lichen sclerosus et atrophicus but is solely of cosmetic concern.
Figure 2. Heavily Scaled Plaque of Reiter Syndrome
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Heavily scaled plaque of Reiter syndrome closely resembles genital psoriasis, but tends to localize to the corona and coronal sulcus.
Figure 3. Deep Ulcerations Within 2 Days of Deliberate Bite
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Ulcerations due to a bite wound will be less indurated but more painful than those due to neoplasia.
Figure 4. Benign Genital Melanosis
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Benign genital melanosis consists of multiple foci of macular pigmentation separated by skip areas of healthy skin and often admixed with areas of moderate hypopigmentation. Malignant melanoma, however, will be substantive to palpation and may be eroded.
Figure 5. Extramammary Paget Syndrome
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Extramammary Paget syndrome, an intraepithelial neoplasm of apocrine sweat gland origin, may be a sign of an underlying malignancy. The well-demarcated erythematous patch may closely simulate psoriasis (if scaling is prominent) or candidiasis (if crusting and erosion are prominent).

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