Lymphedema and painless papules of the vulva.

Abstract

An 86-year-old woman with a history of urothelial bladder cancer currently on enfortumab and pembrolizumab presented with several months of painless papules on the bilateral labia majora, with the extension of induration to the lower abdomen. Computed tomography (CT) scan 2 months prior showed bladder wall thickening secondary to urothelial bladder cancer and subcutaneous edema in the anterior lower pelvis without enlarged lymph nodes or adnexal masses suggestive of metastatic disease. She had no history of transplant, abdominal surgery, or radiation. She wore incontinence garments for bouts of diarrhea. Physical examination revealed confluent firm and nontender pink plaques involving the bilateral labia majora, mons pubis, and lower abdomen (Fig. 1). There were 1–2 mm vesicles at the medial free margins of the clitoral hood. Punch biopsies of both the lower abdomen and right labium majus were performed with histopathologic features shown (Fig. 2).