Agiokeratomas of the Vulva: Possible Association With Radiotherapy

A 52‐year‐old nulliparous white woman was referred for evaluation of asymptomatic multiple dark‐brown vulvar lesions of unknown duration. The lesions were initially noted during routine gynecologic examination. The patient denied any vulvar bleeding, pruritus, pain, edema, or dyspareunia. Her medical history was significant for a staging laporatomy and radiotherapy performed 18 years prior for the treatment of stage 1a Hodgkin's disease. Her medical history included hypothyroidism, Raynaud's syndrome, and chronic hemorrhoids. Physical examination revealed five violaceous, slightly scaly papules ranging in size from 2 mm to 4 mm distributed bilaterally on the labia majoria. No other cutaneous or mucosal lesions were present. Prominent external hemorrhoids were observed. A representative lesion was biopsied. Histologic examination revealed dilated, erythrocyte‐filled vascular spaces immediately beneath a hyperplastic and hyperkeratotic epidermis ( Figure ). Both clinical and histologic findings were consistent with a diagnosis of vulvar angiokeratoma. The patient refused treatment of the lesions. Low‐power (A) and high‐power (B) views of dilated, erythrocyte‐filled vascular spaces immediately beneath a hyperplastic and hyperkeratotic epidermis. image