Vulvar cancer
Vulvar cancer is usually squamous cell carcinoma of the vulvar skin, arising either from high-risk HPV infection (younger, premenopausal patients) or from long-standing lichen sclerosus (older, postmenopausal patients), and is confirmed by punch biopsy of any persistent vulvar lesion or unexplained pruritus; treatment is surgical, with radical vulvectomy and inguinal lymphadenectomy for invasive disease.
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What this article covers
- Overview
A squamous cell carcinoma of the vulvar skin in most cases: vulvar cancer arises from the squamous epithelial lining of the vulva and is usually seen in postmenopausal females.
- Epidemiology
A disease of older women for invasive cancer: vulvar carcinoma is usually seen in postmenopausal females.
- Risk factors
HPV infection with high-risk types 16, 18, and 31: the dominant risk factor in the HPV-related pathway, which trends toward younger, premenopausal patients.
- Pathophysiology
Two convergent carcinogenic routes to the same squamous cell endpoint: persistent infection with high-risk HPV types drives dysplastic transformation of vulvar squamous epithelium in one pathway…
- Clinical features
A new vulvar lesion that itches, burns, or bleeds with manipulation: the presenting symptom in most patients, typically in a postmenopausal woman.
- Differential diagnosis
Vulvar intraepithelial neoplasia (VIN): the precursor lesion itself; distinguished from invasive cancer only by the depth of involvement on biopsy, since both can present with a white, thickened, or pigmented patch.
- Diagnosis
A tissue diagnosis established by vulvar punch biopsy: the diagnosis is confirmed by punch biopsy of any suspicious vulvar lesion, or of persistent vulvar pruritus that fails to respond to standard…
- Management
First, biopsy-confirmed high-grade VIN is treated locally, short of radical surgery: options include topical chemotherapy, laser ablation, wide local excision, skinning vulvectomy, or simple…
- Complications
Malignant transformation from an untreated precursor: VIN left untreated progresses to invasive squamous cell carcinoma.
- Prognosis
Poor once the disease is invasive: vulvar cancer has a poor prognosis, particularly when diagnosis is delayed until an advanced, ulcerated, or exophytic mass has developed.
- Prevention
Biopsy persistent or atypical vulvar pruritus and lesions promptly: any suspicious vulvar lesion or vulvar pruritus that persists despite standard therapy for a presumed benign cause should be…
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