Enhanced Diagnostic Accuracy in Vulvar Skin Disease: The Impact of Dermatopathology and Dermatology Collaboration for Second Opinions

The interpretation of vulvar biopsies can be challenging, especially in cases of inflammatory conditions where there may be significant histologic overlap. Prior studies have highlighted the value of consensus reviews conducted by both gynecologic pathology (GP) and dermatopathology (DP) in improving diagnostic accuracy. To assess the utility of DP consultation in conjunction with a dermatologist with expertise in vulvar disease, we conducted a retrospective review of vulvar biopsies referred for DP consultation by a vulvar dermatologist at a tertiary care vulvar clinic. Among the 17 cases examined, 14 (82%) led to a change in pathologic impression when seen by a dermatologist and interpreted by a DP, while 11 (65%) exhibited discordance in reaction patterns. Notably, inflammatory vulvar biopsies assessed by second opinion were more likely to be categorized according to a reaction pattern (88% vs 52%). In 11 out of 17 cases (64%), second opinions led to changes or expansion in the type of reaction pattern. Overall, there was concordance between DP interpretations and the final clinical diagnosis provided by the dermatologist in 11 of 17 cases (65%). This study underscores the utility of dermatopathology and dermatology consultation in the evaluation of biopsies obtained for vulvar inflammatory disease. The integration of vulvar clinical dermatology with dermatopathology review, particularly through clinicopathologic correlation, likely contributed to the improved diagnostic accuracy.