In most cases, excision of solid lesions is diagnostic as well as therapeutic. Pigmented vulvar lesions include lentigo and nevi. Approximately 2% to 5% of melanomas, but only 0.1% of nevi, are located on the vulva, leading theories that vulvar nevi are at increased risk for malignant transformation (43). As such, detection and careful evaluation of vulvar nevi are critical. The benign lesions of seborrheic keratosis do not require treatment. However, excision can be performed at the patient's request, often for cosmesis.
In the case of acrochordons (fibroepithelial polyps) and hidradenomas, simple excision is curative. These is no evidence that patients with these lesions are at increased risk for malignancy (43). Achrocondon is usually asymptomatic, but repeated trauma and irritation can cause it to become ulcerated. If the lesion is in a troublesome location, such as the panty line or groin fold, it can be removed in an outpatient setting with local anesthesia and simple electrocautery or scissor excision.
Fibroma and related fibromyoma should be removed for diagnostic purposes to exclude a rare leiomyosarcoma or sarcoma. Lipomas usually do not require surgical excision unless they become painful or are cosmetically unacceptable to the patient. Painless, firm, Bartholin's masses, especially postmenopausal, should be excised to rule out Bartholin's gland malignancy (13).
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