Investigations

Question 1

Investigations for SCC prior to sentinel lymph node biopsy

Who for?

Answer 1

The groins can be assessed with ultrasound, but cross-sectional imaging (with computerised
tomography of chest, abdomen and pelvis (CT CAP), or magnetic resonance imaging (MRI)), will
provide additional information on the presence of pelvic lymphadenopathy and distant disease and
should be employed prior to lymphadenectomy.

MRI (pelvis) can be used for further assessment of the loco-regional disease, if locally extensive.

For anyone over Stage IA (stromal involvement over 1mm)

FNA of LN if would change management

Question 2

Investigations for vulval melanoma

Answer 2

Recommended imaging at diagnosis would include CT CAP and also CT or MRI head, since systemic disease and intra-cranial lesions are not uncommon.

Question 3

Investigations for BCC

Answer 3

nil required

Question 4

Investigations for Bartholin’s gland carcinoma

Answer 4

CT CAP is recommended, since these lesions are not suitable for a SLN approach and there is an increased risk of locoregional spread at diagnosis.

MRI pelvis may help to delineate the local degree of involvement.

Question 5

Microscopic features which are important on histological report

Answer 5

Grading -
Squamous carcinomas are graded as well differentiated (grade 1), moderately differentiated (grade 2) and poorly differentiated (grade 3)

Depth of invasion -
This is an independent prognostic factor.

Lymphovascular and/or perineural invasion (PNI) -
Both associated with higher risk of recurrence. Presence of malignant cells in the layers of
the nerve sheath is associated with a worse prognosis.

Clearance margin

Preoneoplastic and non-neoplastic disease -
Presence of lichen sclerosus and differentiated VIN at excision margins

p16 (marker for HPV) /p53 status

Question 6

What size of LN met correlates with poorer survival?

Answer 6

Nodal deposits greater than 5 mm in size have been

shown to correlate with poorer survival

Question 7

When does CK17 immunohistochemistry help?

Answer 7

The utility of CK17 immunohistochemistry in the diagnosis of dVIN has been described, with strong,
diffuse expression favouring dVIN over uVIN and lichen simplex chronicus.

Question 8

What immunohistochemistry can be used for Paget’s disease?

Answer 8

The tumour cells express cytokeratin 7, carcinoembryonic antigen and apocrine cell marker
GCDFP15, which may help to distinguish VPD from other intra-epidermal neoplasms such as malignant
melanoma in situ.

CK7
CEA
GCDFP15

Question 9

Investigations at diagnosis of Paget’s

Answer 9

Consider investigations to exclude a co-existing malignancy of the breast,
gynaecological, urological and colorectal tracts at diagnosis.