Vulval Cancer

Question 1

Types of vulval cancer

Answer 1

Squamous cell carcinoma - most common

Malignant melanoma - rare

Question 2

Risk factors for vulval cancer

Answer 2

Advanced age (particularly over 75 years)
Immunosuppression
Human papillomavirus (HPV) infection
Lichen sclerosus

Question 3

Vulval intraepithelial neoplasia (VIN)

Answer 3

Premalignant condition affecting the squamous epithelium of the skin that can precede vulval cancer

Question 4

Types of VIN

Answer 4

High grade squamous intraepithelial lesion - associated with HPV infection that typically occurs in women aged 35 – 50 years.

Differentiated VIN - associated with lichen sclerosus and occurs in older women (aged 50 – 60 years)

Question 5

Treatment of VIN

Answer 5

Watch and wait with close followup
Wide local excision (surgery) to remove the lesion
Imiquimod cream
Laser ablation

Question 6

Presentation of vulval cancer

Answer 6

Vulval lump
Ulceration
Bleeding
Pain
Itching
Lymphadenopathy in the groin

Most frequently affects the labia majora:

• Irregular mass
• Fungating lesion
• Ulceration
• Bleeding

Question 7

Management of vulval cancer

Answer 7

Wide local excision to remove the cancer
Groin lymph node dissection
Chemotherapy
Radiotherapy

Question 8

Investigations for vulval cancer

Answer 8

Biopsy of the lesion
Sentinel node biopsy to demonstrate lymph node spread
Staging CT