Review Topic
  • A 62-year-old woman presents with vaginal itching. She denies any trauma, any abnormal odors, or vaginal discharges. She noted a lump on her vulva. She has a history of cigarette smoking and has not quit. Pelvic examination is notable for ulcerative lesion in the left labia majora. A biopsy is performed, which is positive for squamous cell carcinoma.
  • Overview
    • cancer affecting the vulva
      • squamous cell carcinoma is the most common histologic type (~75% of cases)
        • other histologic types include
          • melanoma
          • basal cell carcinoma
          • Bartholin gland adenocarcinoma
          • sarcoma
          • Paget disease
        • most common cause is human papilloma virus (HPV) infection
  • Epidemiology
    • incidence
      • most frequently occurs between 65-75 years of age
      • fourth most common gynecologic malignancy
        • after uterine, ovarian, and cervical
    • risk factors
      • HPV
      • tobacco use
      • high risk sexual activity
      • vulvar intraepithelial neoplasia (VIN)
      • cervical intraepithelial neoplasia (CIN)
      • vulvar lichen sclerosis
    • protective factors
      • HPV vaccination
      • smoking cessation
  • Pathophysiology
    • vulvar squamous cell adenocarcinoma can be secondary to
      • HPV infection
      • chronic inflammatory or autoimmune process
  • Symptoms
    • pruritus
    • patients may report vulvar bleeding or pain
  • Physical exam
    • vulvar lesion
      • plaque, ulcer, or mass
        • most commonly on the labia major
        • lesions in squamous cell carcinoma are
          • firm
          • white, red, or skin-colored
  • Invasive studies
    • biopsy
      • indication
        • confirms the diagnosis
    • colposcopy
      • indication
        • used to visualize the vulva if lesions are not appreciated grossly
  • Vaginal cancer
    • differentiating factors
      • malignant cells arising from the vagina
  • Surgical
    • excision
      • indication
        • treatment of choice for local disease
  • Surgical complications
    • sexual dysfunction
    • urinary and fecal incontinence
    • introital stenosis

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