About two-thirds of primary care ARI visits may not be necessary for appropriate antibiotic management.

The vulva is an unusual site for basal cell carcinoma (BCC). Vulvar BCC accounts for <1% of all BCCs and <5% of all vulvar malignancies. We report the case of an 83 year-old woman who presented with a 2-month history of a tender labial growth, with histopathology confirming nodular BCC. We conducted a systematic literature review of the characteristics of reported cases of vulvar BCCs. A comprehensive systematic review of articles indexed for MEDLINE and Embase yielded 96 reports describing 437 patients with 446 BCCs of the vulva. The mean age at presentation was 70 (range 20-100). Most women had no underlying vulvar disease. Approximately 60% of cases were of the nodular subtype.Treatment approach varied widely with over half of cases treated with wide local or local excision. Mohs micrographic surgery (MMS) for vulvar BCC was first reported in 1988 with seven total MMS cases reported. Twenty-three cases of recurrence have been reported; 21 of these cases after local excision but none following MMS. Vulvar BCC is a rarely reported cancer that affects older women predominantly. MMS represents a promising treatment for BCC in this anatomic location. Case ReportAn 83-year-old woman with a 40-year history of treated lichen sclerosus presented with a tender growth in the genital area for 2 months. Genital examination revealed a 5-mm eroded papule on the right inferolateral labium majus arising on normal skin, and a white, sclerotic appearance of the labia minora and clitoris ( Fig. 1). Biopsy of the papule revealed a nodular BCC.The patient underwent MMS. She has no evidence of disease recurrence at 3 years.

Perivascular epithelioid cell tumors (PEComas) are mesenchymal neoplasms with characteristic epithelioid or spindled cytomorphology that typically grow around blood vessels. These tumors are phenotypically and immunohistochemically distinct, expressing markers of both melanocytic and smooth muscle differentiation. Herein, we describe a case of histopathologically malignant cutaneous PEComa without metastatic spread, with review of the pertinent literature. Telescoping punch biopsy demonstrated an epithelioid neoplasm with marked atypia, hypercellularity, and increased mitotic activity. Immunohistochemical stains for HMB‐45, NK1‐C3, PGP9.5, MiTF, CD10, and CD68 were positive within tumor cells. In addition, there was diffuse expression of caldesmon and focal cytoplasmic staining for smooth muscle actin on the excision specimen. The patient underwent treatment with surgical excision with adjuvant radiation and surveillance computed tomography (CT). The patient remains free of recurrence or metastatic disease after 10 months of follow‐up. To our knowledge, this is only the third reported case of a malignant cutaneous PEComa reported in the literature to date.

Acute genital vulvar ulcerations are non-sexually acquired lesions characterized by sudden onset of a few genital ulcers, presented typically in girls and young women. The terms AGU or Lipsch€ utz ulceration are used to describe ulcers associated with an immunologic reaction to a distant source of infection or inflammation. 6 The most common triggering factors are infectious diseases, specially flu-like and mononucleosis syndrome infections. 5,7 In many cases, the patients present also other symptoms, mainly oral aphthae, malaise, lymphadenopathy or fever, 8 and concomitant cutaneous manifestations such as erythema nodosum can also be observed. 6 Therapies for AGU include anti-inflammatory drugs, topical anaesthetics and corticosteroids. When a triggering infection is documented, antimicrobial agents are also useful for the management of the ulcerations. The lesions commonly resolve within 3 weeks. Some virus species have been well defined as triggering agents of Lipsch€ utz ulcers, specially Epstein-Barr virus. Although SARS Coronavirus 2 has been associated with oral ulcers, 9 we did not find previous reports of coronavirus-related AGU in the English literature. We report this case in order to describe a potential reactive dermatologic manifestation of the COVID-19. Moreover, we propose that Lipsch€ utz ulcers could be triggered by SARS Coronavirus 2, comparably to other respiratory virus infections. Acknowledgement The patients in this manuscript have given written informed consent to the publication of their case details.

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