Cancers of the vulva and penis, with the most common subtype being squamous cell carcinoma, can also present as genital ulcers, but leukemias such as chronic lymphocytic leukemia and acute promyelotic leukemia have also been identified. Infectious non-sexually transmitted causes
Even lesser common etiologies of genital ulcers include fungal infection, secondary bacterial infections, and parasitic infections.Fungal infections are rare causes of genital ulcers, but candida albicans infection is typically the most common source, and is more prevalent in patients with a history of diabetes mellitus, chronic steroid use, or other immunodeficiencies. There have also been rare case reports of paracoccidioidomycosis, zygomycosis and histoplasmosis infections causing genital ulcers.Parasitic infections such as amoebiasis and leishmaniasis can present in cutaneous form in the genital regions. This can be confused with a sexually transmitted disease or sepsis due to their tendency to present with additional systemic symptoms.Genital tuberculosis can also present as a genital ulcer, either in the form of cutaneous tuberculosis from a systemic infection, or a primary tuberculosis chancre at the site of inoculation via direct genital contact with infected sputum. Cutaneous tuberculosis typically presents initially as red or yellow nodules that eventually break down to form soft, painful, and roughly circular ulcers, which as a rule are covered in a pseudomembrane. Primary tuberculosis chancre, on the other hand, often presents as a painless ulcer with well defined edges that appears rather nonspecific. References
External links
Genital herpes - self-care, A.D.A.M.
Diagnosis can often be difficult because of the rareness of ECD as well as the need to differentiate it from LCH. A diagnosis from neurological imaging may not be definitive. The presence of symmetrical cerebellar and pontine signal changes on T2-weighted images seem to be typical of ECD, however, multiple sclerosis and metabolic diseases must also be considered in the differential diagnosis. ECD is not a common cause of exophthalmos but can be diagnosed by biopsy. However, like all biopsies, this may be inconclusive. Video-assisted thoracoscopic surgery may be used for diagnostic confirmation and also for therapeutic relief of recurrent pericardial fluid drainage. Histology
Histologically, ECD differs from Langerhans cell histiocytosis (LCH) in a number of ways. Unlike LCH, ECD does not stain positive for S-100 proteins or Group 1 CD1a glycoproteins, and electron microscopy of cell cytoplasm does not disclose Birbeck granules. Tissue samples show xanthomatous or xanthogranulomatous infiltration by lipid-laden or foamy histiocytes, and are usually surrounded by fibrosis. Bone biopsy is said to offer the greatest likelihood of reaching a diagnosis. In some, there is histiocyte proliferation, and on staining, the section is CD68+ and CD1a-. Treatment
Current treatment options include:

Surgical debulking
High-dose corticosteroid therapy
Ciclosporin
Interferon-α
Chemotherapy
Vemurafenib. It would appear that approximately half these patients harbor point mutations of the BRAF gene at codon 600 substituting the amino acid glutamine for valine. Vemurafenib, an oral FDA approved targeted agent to the BRAF protein for melanoma, shows dramatic activity in patients Erdheim–Chester disease whose tumor contains the same mutation. In 2017 the US FDA approved vemurafenib for this indication.