Diagnostic Pearls of Vulvar Epidermolytic Acanthoma: Case Report

Abstract

Epidermolytic acanthomas (EA) are uncommon benign tumors clinically presenting as single to multiple papules. Histologically, EA display hyperkeratosis, hypergranulosis, acanthosis, and epidermal degeneration-also known as epidermolytic hyperkeratosis (EH). EA may be misdiagnosed as condyloma both clinically and histopathologically when located on the genitalia. Thus, this diagnosis carries a significant psychological burden and must remain in the differential when initially considering genital warts. We utilize the case of a 62-year old female referred to dermatology for a 5-year history of multiple pruritic and hypopigmented vulvar papules-misdiagnosed as genital warts-to highlight the impact of differentiating EA from genital warts. This patient was initially misdiagnosed with common genital warts at her gynecologist's office and treated unsuccessfully for years. A shave biopsy was performed and histology revealed EH, consistent with EA.

Keywords: Condylomata acuminata; Epidermolytic acanthoma; Vulvar epidermolytic acanthoma.

Fig. 1. Multiple skin-colored verrucous papules, some with central umbilication and keratin plugs on the labia majora.

Fig. 2. (A) A cup shaped lesion with hyperkeratosis, acanthosis, and papillomatosis with vacuolation of keratinocytes within the granular layer (H&E, 40×). (B) Large basophilic granules are present in the granular layer and fine eosinophilic granules are present in the granular and spinous layer, representing epidermolysis (H&E, 200×).