Assessing Genital Skin Lesions

Vlada Groysman, MD, is Founder and Medical Director of Cahaba Dermatology & Skin Health Center in Birmingham, Alabama.

“I think sometimes we’re… reluctant to examine the genitalia, but… we should be treating a lot of the disorders that our colleagues in obstetrics and gynecology are probably not familiar with,” said Vlada Groysman, MD, Cahaba Dermatology, Birmingham, Alabama.

Dr. Groysman, the only vulvar dermatologist in the state of Alabama, recently spoke about the dermatologist’s important role in diagnosing and treating genital skin lesions at the Alabama Dermatology Society 2021 Summer Symposium. 

According to Dr. Groysman, assessing genital skin lesions should be a top priority among dermatologists, especially since dermatologists are more likely to diagnose disorders like lichen planus and lichen sclerosus, which, she pointed out, can look similar.

“Lichen sclerosis presents with scarring and agglutination and just destruction of vulvar structures and so can lichen planus… it’s key to differentiate them, because obviously the treatment is a little bit different as well.”

Genital warts and seborrheic keratosis are also sometimes confused.

“…what we really need to understand is that if the genital wart does not improve with cryotherapy we should probably biopsy it,” said Dr. Groysman.

Notably, dermatologists send biopsies to a dermatopathologist vs. a clinical pathologist, which makes misdiagnosis less likely.

“I think the key thing with vulvar derm is biopsy first, ask questions later. I think that there’s a lot of things that can look like each other. I always offer [patients] at least a biopsy… let’s find out what’s really going on.”

While Dr. Groysman includes the genitalia as part of full body skin exams, those dermatologists who do not may pick up on indications that a genital skin exam is warranted, for example, patients will describe itching or chronic urinary tract infections.

“I think that we just need to listen to our patients,” said Dr. Groysman. “And part of all of our full body skin check should be examining the genitalia, unless of course the patient declines.”