What additional finding would suggest a diagnosis of vulvar carcinoma in a patient with vulvar pain and tenderness?

The presence of white, lichenified, and adherent plaques on the bilateral labia minora is a significant indicator that can suggest a diagnosis of vulvar carcinoma, especially in the context of vulvar pain and tenderness. These characteristics point towards a likely neoplastic process or chronic irritation that may predispose the area to cancer.

Lichenification indicates chronic irritation or inflammation, and the adherence of plaques can reflect the persistent change in skin texture associated with malignancy. This finding could suggest either the presence of an underlying malignant transformation or a precursor lesion, such as lichen simplex chronicus or vulvar intraepithelial neoplasia (VIN), which are associated with an increased risk of vulvar carcinoma.

In contrast, the other findings listed do not carry the same weight as indicators of malignancy. For instance, a friable, bright red papule at the urethral meatus could suggest an inflammatory process or a benign condition but lacks the definitive characteristics associated with cancer. Inflamed, red dome-shaped papules with central umbilication could suggest molluscum contagiosum, a viral infection that is not indicative of cancer. Finally, pink, sharply marginated smooth papules could correspond to benign conditions like genital warts or other