As with the majority of skin biopsies I receive, this biopsy from an elderly lady was accompanied by no history or clinical description. I noticed the syringoma right away but picked up the lichen sclerosus only on second glance. I have no idea what the gynecologist was going for, so he or she will have to sort it all out.

Not to get off on a parenthetical rant here, but considering that almost everyone who works in a gynecologist's office is female, the level of ignorance concerning the simple anatomy of the female external genitalia is stultifying. Biopsies from the vulva are labeled "vagina" in about half the cases, and even after thirty years, I have yet to see anyone use the correct singular forms, "labium minus" and "labium majus," on a tissue requisition.

Mothers, you need to teach your little girls the difference between their vulva and vagina. The two structures are subject to totally different sets of diseases, and mislabeling a biopsy specimen can result in a serious diagnostic error.