Benign Vulvar Lesions - Symptoms, Types, and Treatment

What Are the Benign Vulvar Lesions?

A non-cancerous (benign) vulvar lesion does not spread to other body regions (metastasize). Non-cancerous lesions are rarely life-threatening. They usually are removed through surgery and do not reappear. Vaginal neoplasms are divided into two categories: cystic tumors and solid lesions, as well as a few other conditions. A pelvic exam and biopsy are frequently used to determine the type of lesion. Mild cases may not need treatment, but lesions that are causing problems or that have the potential to become malignant should be removed surgically or nonsurgically.

What Are the Symptoms of Benign Vulvar Lesions?

Vaginal tumors usually do not cause any symptoms until they have grown to a large size. They are usually discovered during a normal pelvic examination.

However, some frequent symptoms of advanced-stage lesions include-

• Pressure sensation.

• Painful sexual encounters.

• A urethral or vaginal blockage.

• Unusual vaginal bleeding.

What Are the Various Benign Vulvar Lesions?

1. Benign Vulvar Tumors- Benign vulvar tumors begin in connective tissue and include fibrous and muscle tissue tumors (fibromas, fibromyomas, and dermatofibromas), fatty tissue tumors (lipomas), or blood vessel tumors (hemangiomas). Most non-cancerous tumors are diagnosed via an excisional biopsy, eliminating the risk of cancer. Treatment for non-cancerous vulvar tumors varies depending on the type of tumor, although it usually involves surgical removal.

• Leiomyomas- Leiomyomas are formed from vulva smooth muscle components. The tumors usually are smooth and movable, and the most commonly develop in the labia majora. Local excision is the treatment. Other gynecologic leiomyomas have the same histologic characteristics as this one.

• Lipoma- Lipomas of the vulva share many of the same characteristics as lipomas seen elsewhere on the body. They form in vulvar fatty tissue and rarely grow larger than 4 cm. They are made up of mature fat cells with a thin capsule. Local excision is the treatment.

• Fibroma- Fibromas appear as small exophytic protrusions on the vulva. They may grow in size and cause symptoms. Lesions on the labia majora are the most common. Leiomyomas have a similar histologic appearance to leiomyomas. Local excision is used as treatment.

• Neurofibroma- These are dermal tumors. After puberty, they appear as tiny, flesh-colored, pedunculated sores on the labia. Vulvar neurofibromatosis is common in patients with von Recklinghausen's disease. They can sometimes grow into a bigger mass that is symptomatic and requires excision; otherwise, no treatment is necessary.

• Hidradenoma- Apocrine sweat gland tumors are known as hidradenoma. Some of them may come from the eccrine sweat glands. They normally have a diameter of less than 1 cm and appear on the medial aspect of the labia majora. The lesions are solid and move about freely. If the lesion joins with the epithelial surface, it might cause ulceration and discomfort. Surgical excision is the treatment.

• Syringoma- Syringomas are eccrine sweat gland hamartomas that are tiny and benign. Multiple lesions are common, and they can appear on different body parts. Because the lesions are asymptomatic, no treatment is required unless pain or pruritus develops.

• Pigmented Vulvar Tumors- Lentigines, vulvar melanosis, and nevi are three types of benign pigmented lesions. Lentigines are tiny macules with well-defined circumference. Vulvar melanosis is a larger lesion with an uneven border than lentigo. Nevi that are irritated or bleeding should be removed.

• Granular Cell Tumors (Granular Cell Myoblastoma)- Firm nodules with inadequate encapsulation commonly found on the labia majora. These asymptomatic, slow-growing benign neoplasms emerge from neural tissue and can occur in either a deep or superficial epidermal site. Local excision is the treatment. The lesion may return if the excision is not complete.

• Vascular Tumors- Capillary hemangioma, cavernous hemangioma, angiokeratoma, lymphangioma, and Kaposi's sarcoma are all vascular and lymphatic tissue malformations that can arise on the vulva.

• Endometriosis- The vulva may develop ectopic endometrial tissue. Endometriosis of the vulva is most commonly found in healed episiotomy scars. The optimum technique of management is excision. Recurrences are extremely common.

• Glandular Cysts- Vulvar tumors can be caused by cystic expansion of the vulvar glands. Both Bartholin's duct and Skene's duct cysts are possible. Blockage of the gland duct and continuing secretion or infection of the gland are pathophysiologic characteristics.

2. Benign Vulvar Cysts- An obstruction of the ducts or glands in the vulva area causes non-cancerous vulvar cysts. Following are the commonly occurring cysts-

• Bartholin Cysts- The most frequent form of vulvar cyst is a Bartholin cyst. They usually develop as a painless bump on bartholin duct present on the vaginal wall. The lump can become painful if an abscess develops.

• Skene’s Cyst- Skene's cysts form in the Skene's glands, which are located near the urethral entrance.

The following treatments can be done-

• If an abscess develops, the cyst can be drained, and antibiotics can be administered.
• Marsupialization - Cysts that persist or return after they have been drained - suturing the cyst open to allow it to drain and decrease gradually.
• Cysts that keep reappearing are surgically removed.
• The cyst is surgically removed because of the higher risk of vulvar cancer in older women.

3. Other Benign Conditions- The skin of the vulva is affected by a variety of non-cancerous disorders. Itching of the affected area of the vulva is a common symptom of many of these disorders. Lichen sclerosus, genital warts, and squamous cell hyperplasia are all non-cancerous conditions of the vulva. However, warts and squamous cell hyperplasia can sometimes turn cancerous also.

• Lichen Sclerosus- Lichen sclerosus is a chronic skin condition that primarily affects the vulva and the area surrounding the anus. Corticosteroid cream is frequently used to treat lichen sclerosus.

• Condyloma Acuminatum or Genital Warts- Skin growths in the groin, genital, and anal areas are known as genital warts. It occurs due to HPV (human papillomavirus) infection. Enlargement and progression of condylomatous lesions are linked to immunocompromised states and pregnancy. Warts can be treated with drugs or removed by laser surgery, freezing (cryosurgery), or surgical removal.

• Squamous Cell Hyperplasia- Squamous cell hyperplasia is characterized by thicker skin due to enhanced cell proliferation. Avoiding irritant soaps and using corticosteroid cream are the treatment modalities.

• Acrochordon- In the vulvar epithelium, fibroepithelial polyps are very common. They are also called skin tags. This lesion is non-cancerous. Polypoid structures that are soft and flesh-colored. Acrochordon lacks skin appendages and hair. Symptomatic lesions are treated by removing them locally.

Conclusion-

The benign vulvar lesions occur rarely and mostly remain undiagnosed. They cause very mild symptoms and are usually diagnosed accidentally during a routine pelvic examination. Once diagnosed, the patient must get it excised or monitor it regularly to avoid any malignant transformations. However, benign lesions of the vulva usually have a good prognosis.