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Vulval sarcoid: A systemic presentation of sarcoidosis

1996). Genetic studies have isolated several genes that regulate sebaceous gland activity; these studies, on animal models, have demonstrated that overexpression of Smad7, c-myc and Parathormone-related protein (Zouboulis and Boschnakow 2001) led to sebaceous gland hyperplasia. However, none of the factors described have been found to be a contributing cause in this particular case. From consideration of the four documented cases, the clinical appearance of the lesions differs on the labia minora and labia majora. The lesions on the surface of the labia majora were polypoid, whereas those on the labia minora were enveloped within the labia themselves. This gave the appearance of a general enlargement of the labia minora, making them technically more difficult to excise, as it was in this case. The large size of the lesion here distinguishes it from the three previously reported cases. The clinical signs of an apparently positive cough impulse and the reducibility of the lesion confounded the differential diagnoses. Due to its extent, excising the lesion in its entirety would require a larger incision, potentially increasing the patient’s morbidity. Therefore, a decision was taken to limit the dissection. The swelling was partially excised with the excess labial skin and the size of the right labium reduced. Unlike the facial lesions, clinical diagnosis of sebaceous gland hyperplasia of the vulva is not possible without histological examination. Treatment of the lesions is usually for cosmetic reasons but larger lesions such as those on the vulva could cause discomfort and require excision. Although other forms of treatment for sebaceous gland hyperplasia have been described, such as topical medication, electrocautery, cryocautery and laser therapy, excision was deemed the appropriate management in this case due to its size and anatomical site. As the lesion was incompletely excised, recurrence was a concern for this patient. However, after 1 year, the patient has not represented with the problem.