Differential Diagnosis for Genital Lesion

Given the description of a genital lesion inside the labial minora that is non-erythematous, tender to the touch, resembles an extra skin lesion, has intact skin, and is not vesicular or pustular, the following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Follicular cyst: This is a common condition that can present as a small, tender nodule, often resembling an extra piece of skin. It occurs when a hair follicle becomes blocked, leading to cyst formation. The description provided matches closely with the clinical presentation of a follicular cyst.

• Other Likely Diagnoses

  • Epidermal inclusion cyst: These are benign cysts that can form when skin cells are trapped beneath the skin surface, leading to a small, usually painless, lump. However, they can become tender if inflamed or infected.
  • Mucous cyst: Although less common in the genital area, mucous cysts can occur and present as small, usually benign lesions.
  • Vulvar syringoma: These are benign tumors that can appear as small, firm, skin-colored bumps on the vulva, including the labial minora.

• Do Not Miss Diagnoses

  • Bartholin gland cyst or abscess: Although the description does not perfectly match (as these are typically located near the vaginal opening and can be very painful), it's crucial to consider due to the potential for severe infection and the need for prompt drainage.
  • Squamous cell carcinoma: While rare, any new or changing lesion in the genital area warrants consideration of malignancy, especially in older adults or those with risk factors like HPV infection.
  • Genital warts (condyloma acuminata): Caused by HPV, these can present as small, flesh-colored or gray swellings in the genital area, though they are often more verrucous in appearance.

• Rare Diagnoses

  • Vulvar adenocarcinoma: A rare type of cancer that could present as a lump or lesion in the vulvar area.
  • Neurofibroma: A rare, benign tumor of the nerve tissue that could present as a firm, skin-colored nodule.
  • Vulvar leiomyoma: A rare, benign tumor of smooth muscle origin that could appear as a firm, skin-colored nodule in the vulvar area.

Given the long wait to see an OBGYN, primary care management could involve:

• Monitoring the lesion for changes in size, color, or symptoms.
• Considering a trial of warm compresses or over-the-counter pain relievers for symptomatic relief if the lesion is tender.
• Referral to a dermatologist if the lesion has characteristics concerning for skin cancer or if the diagnosis is unclear.
• Urgent referral to an OBGYN or emergency department if signs of infection (increased redness, swelling, purulent discharge, fever) or severe symptoms develop.