原文：
現(xiàn)病史：患者為26歲女性，主訴外陰腫物11月。2014年3月開始出現(xiàn)右側小陰唇瘙癢，最終出現(xiàn)花生米大小粉色腫塊，實質，偶有破裂，伴有實性物質。腫物不斷長大，患者自行用藥克霉唑、氫化可的松乳膏和新孢霉素，均未見效，并最終于2015年1月15日就醫(yī)。腫物于2015年1月16日由患者的初級護理醫(yī)師（PCP）在診室內切除，病理示：痣樣惡性黑色素瘤，Clark等級IV，深度3 mm。PCP將上述結果告知患者，并推薦到我們診室就診。發(fā)病以來，患者體重未有明顯變化，右側腹股溝存在數(shù)個結節(jié)性紅斑。此外，左髖有一小型皮下腫塊，該腫塊在外陰腫塊出現(xiàn)前就存在，大小一直未變。

患者于2015年2月6日在我診所進行病情評價，在此期間我們?yōu)g覽了活檢結果。檢查發(fā)現(xiàn)，患者右側小范圍腹股溝淋巴結病，行MRI及PET/CT掃描以確定病灶范圍。PET示：病灶未轉移。頸部淋巴結輕度代謝增強，考慮炎癥；左耳病變，炎癥可能。MRI未見淋巴結病。左臀病灶約1 cm，無增強?；颊咝须p側前哨淋巴結活檢、右側外陰根治術、左臀及左耳病灶切除術。手術順利，失血量約50 ml。

譯文：

HISTORY OF PRESENT ILLNESS:

The patient was 26 year old girl who reports an 11 month history of a vulvar mass. She reports itching on her right labia minora starting March 2014 with ultimate growth of a "peanut-sized fresh pink" bump that was solid and occasionally ruptured with expression of solid material. The mass grew, and she attempted clotrimazole, hydrocortisone cream, and neosporin without success. She ultimately sought medical care on January 15, 2015. It was excised in-office by her PCP on January 16, 2015 with pathology revealing malignant melanoma, nevoid type, Clark level IV to depth of 3mm. She was notified of these findings by her PCP and referred to our office. The patient reports no changes in weight, some right inguinal bumps, and a small subcutaneous bump on her left hip that she says has been present since prior to the vulvar mass but is not growing in size. 

The patient was evaluated in our clinic on February 6, 2015 during which the results of her office biopsy was reviewed. On exam patient had small right inguinal lymphadenopathy for which she was sent for an MRI and PET/CT scan to determine the extent of this lesion. She also had a PET scan that showed no evidence of metastatic disease. There were mildly hypermetabolic lymph nodes in the neck that are thought to be inflammatory and a left ear lesion that may be inflammatory in origin. MRI shows no lymphadenopathy. The left gluteal lesion is about 1 cm, but non-enhancing. Patient underwent an uncomplicated bilateral sentinel lymph node biopsies, radical right vulvectomy, left buttock and left ear lesion removal. Procedure was uncomplicated with an EBL of 50 mL.