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  • Snapshot
    • 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.
  • Introduction
    • 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
  • Presentation
    • 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
  • Studies
    • Invasive studies
      • biopsy
        • indication
          • confirms the diagnosis
      • colposcopy
        • indication
          • used to visualize the vulva if lesions are not appreciated grossly
  • Differential
    • Vaginal cancer
      • differentiating factors
        • malignant cells arising from the vagina
  • Treatment
    • Surgical
      • excision
        • indication
          • treatment of choice for local disease
  • Complications
    • Surgical complications
      • sexual dysfunction
      • urinary and fecal incontinence
      • introital stenosis
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