MLA Domain 5 · Presentation

Vulval/ vaginal lump

7 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 3

Lichen sclerosus

Persistent ulcer/lump or thickened area → biopsy to exclude vulval squamous cell carcinoma

Trichomoniasis

Pregnancy (preterm birth, low birth weight association)

Vulvovaginal candidiasis

Recurrent (≥4/year) → check diabetes/immunosuppression; pregnancy (oral azoles avoided)

recognised feature · 1

Vulval cancer

Any persistent vulval lump/ulcer → biopsy (do not treat as infection indefinitely)

differential of the above · 3

Bacterial vaginosis

Pregnancy (preterm birth, late miscarriage association)

Lichen planus

Erosive oral or genital lichen planus has a small risk of squamous cell carcinoma — long-term monitoring

Vitiligo

Major psychosocial impact (especially in skin of colour); depigmented skin burns easily (sun protection)