VULVAL CANCER

Question 0

What is lichen sclerosis? Sx? Rx?

Answer 0

Thin Atrophic labia, membrane like epithelium. Subepithelial fat becomes diminished.

Sx
Pruitus
Dysparenia
Burning

Rx
Ultra potent Topical steroids 0.05% clobetasol then taper down

Question 1

What are the types?

Answer 1

Squamous cell carcinomas (majority), associated with HPV 16,18, 33

Melanoma (2nd most common)
Basal cell carcinoma
Extra mammary Paget’s disease

Question 2

What are the theories associated with Pathogenesis?

Answer 2

Secondary to

• HPV (60%)
• chronic inflammation I.e. Due to lichen sclerosis

Question 3

Risk factors?

Answer 3

Previous vin or cin 
HPV 
Vulvular dystrophy (lichen sclerosis) 
Immunosuppressive 
Smoking 

Most diagnoses stage 1 with 90% survival rate

Question 4

Signs and symptoms?

Answer 4

Vulvar priutus mc

Labia majors lesion e.g. Nodule, plaque, ulcer or mass

LC labia minora, clitoris
LC multi focal I.e. Vulvular and perianal skin involved

Question 5

Investigations?

Answer 5

Lab
Punch biopsy -/+ colposcopy

Rad
If chronic, colposcopy exam of vulva and biopsy

Question 6

Rx?

Answer 6

If stage I or II

• radical local excision and unilateral lymphadenectomy
• radiotherapy

III
- radical resection, lymphadenectomy and radiotherapy

IV
Chemo