Stamm Andrew W, Kobashi Kathleen C, Stefanovic Ksenija B
Virginia Mason Medical Center, Seattle, WA, USA.
Curr Urol Rep. 2017 Aug;18(8):62. doi: 10.1007/s11934-017-0712-9.
Genital dermatology represents a challenge to many providers. Though dermatologic lesions involving the genitalia may present to any of a number of practices, ranging from primary care to urology, gynecology, and dermatology, few training programs provide significant training regarding the diagnosis and management of genital dermatologic lesions. The purpose of this review is to provide urologists with an overview of common genital dermatological lesions that may be encountered in a clinic. The review also provides a guide to how to approach these conditions.
This manuscript summarizes the most common categories of genital dermatologic lesions, starting with normal variants and progressing to a review of contagious conditions, premalignant lesions, and malignant lesions. In cases in which a lesion does not definitively belong to one of these categories, an algorithmic approach to making a diagnosis may be helpful to narrow the differential diagnosis. The most common benign genital growths include cysts, syringomas, seborrheic keratosis, pearly papules, and Fordyce spots. Contagious lesions, such as herpes, syphilis, scabies, or molluscum contagiosum, should be treated immediately before complications or transmission can occur. Inflammatory genital lesions are very diverse in etiology and presentation but are the most common genital lesions in urological clinical practice. This category of lesions can be approached by dividing them into non-erythematous and erythematous (scaling and non-scaling) lesions. Given the potential evolution of the challenging category of premalignant genital lesions, proper recognition and early biopsy play an important role. Premalignant lesions can be broadly classified into two categories: those not related to HPV infection and those that are related to HPV, including erythroplasia of Queyrat (EQ), Bowen's disease, Bowenoid papulosis, vulvar intraepithelial neoplasia (VIN), and giant condyloma. Herein, contemporary nomenclature and proper evaluation and management of premalignant lesions are reviewed which provide safe and efficacious outcomes for patients. Finally, malignant genital lesions, though rare, must be recognized early and addressed correctly. Squamous cell carcinoma represents 95% of penile and approximately 90% of vulvar and vaginal malignancies, and diagnosis and management can be challenging and require proper referral to an oncologist. Genital dermatology is a challenging field marked by diagnostic difficulty and management challenges. This manuscript provides an overview of genitourinary dermatologic lesions in an effort to provide clinicians with a framework with which to approach the evaluation of these various conditions that will facilitate proper consideration of the differential diagnoses and help the urologist distinguish between normal, benign, premalignant, and malignant lesions.
生殖器皮肤病学对许多医疗服务提供者来说是一项挑战。尽管涉及生殖器的皮肤病损可能出现在从初级保健到泌尿外科、妇科和皮肤科等多种医疗实践中，但很少有培训项目提供关于生殖器皮肤病损诊断和管理的重要培训。本综述的目的是为泌尿科医生概述临床中可能遇到的常见生殖器皮肤病变，并提供处理这些病症的指南。
本文总结了生殖器皮肤病变最常见的类别，从正常变异开始，进而综述传染性疾病、癌前病变和恶性病变。在病变不能明确归为这些类别之一的情况下，采用算法方法进行诊断可能有助于缩小鉴别诊断范围。最常见的良性生殖器肿物包括囊肿、汗管瘤、脂溢性角化病、珍珠状丘疹和福代斯斑。传染性病变，如疱疹、梅毒、疥疮或传染性软疣，应在出现并发症或传播之前立即治疗。炎性生殖器病变在病因和表现上非常多样，但在泌尿外科临床实践中是最常见的生殖器病变。这类病变可通过将其分为非红斑性和红斑性（有鳞屑和无鳞屑）病变来处理。鉴于具有挑战性的生殖器癌前病变可能发生演变，正确识别和早期活检起着重要作用。癌前病变大致可分为两类：与HPV感染无关的病变和与HPV相关的病变，包括凯腊增殖性红斑（EQ）、鲍温病、鲍温样丘疹病、外阴上皮内瘤变（VIN）和巨大尖锐湿疣。本文对癌前病变的当代命名以及正确的评估和管理进行了综述，为患者提供安全有效的治疗结果。最后，恶性生殖器病变虽然罕见，但必须尽早识别并正确处理。鳞状细胞癌占阴茎恶性肿瘤的95%，外阴和阴道恶性肿瘤的约90%，其诊断和管理具有挑战性，需要正确转诊给肿瘤学家。生殖器皮肤病学是一个具有挑战性的领域，其特点是诊断困难和管理挑战。本文概述了泌尿生殖系统皮肤病变，旨在为临床医生提供一个框架，用于处理这些各种病症的评估，这将有助于正确考虑鉴别诊断，并帮助泌尿科医生区分正常、良性、癌前和恶性病变。
