Approach to vulvar skin disorders Quiz: Ace Your Exams

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A 61-year-old woman presents to the clinic with a three-month history of progressively worsening vulvar pruritus that has not responded to over-the-counter antifungal treatment. She has no postmenopausal bleeding and is not sexually active due to vaginal discomfort since menopause. Past medical history is notable for a positive human papillomavirus (HPV) test on routine cervical cancer screening at age 30 that resolved spontaneously. She doesn’t take any daily medications. Vital signs are within normal limits. On physical exam, vulvar atrophy is prominent with thin, fragile, hypopigmented skin across the vulva. Colposcopy demonstrates leukoplakia and an atypical underlying vascular pattern. A biopsy of the fragile, hypopigmented skin shows hyperkeratosis and an inflammatory pattern. Which of the following is true regarding the most likely underlying condition?

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It is typically associated with HPV types 6 and 11.

It is not typically associated with HPV.

It is malignant.

It is typically associated with HPV types 16 and 18.

It is associated with an increased risk of vulvar adenocarcinoma.