Pigmented lesions of the vulva will usually require biopsy for diagnosis, and 3% of melanomas occur on the vulva that has about 1.5% of the body skin area. Actinic radiation, sunlight, may play a role in the development of melanoma in exposed areas of skin, but the relatively high risk for melanoma of the vulva does not seem to reflect that origin (45,46).
A host of common or rare dermatologic and other diseases may present on the vulva, and a liberal policy of biopsy for visible or symptomatic lesions is mandatory. Access to the world literature through PubMed or other library source is especially important for diagnosis of unusual lesions whose gross clinical appearance may not be diagnostic (47) or for diseases not frequently treated by those who manage vulvar complaints (e.g.: aggressive angiomyxoma) (48,49).
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