The pelvic examination begins with a visual inspection of the external geni- talia using the assistance of a good light source. Although skin cancer is rare in this region, it is often diagnosed late. Vulvar cancer can be hyperpig- mented, erythematous, or hypopigmented, and any such lesions require care- ful evaluation and often biopsy (see Chapter 17). Lichen sclerosus is a relatively common condition in which the vulvar skin may appear like parch- ment. It is more common in postmenopausal women, but occurs in all ages, and can be associated with cancer. .
