Vulval Carcinoma (& Vulval Intraepithelial Neoplasia)

Question 1

What is Vulval Intraepithelial Neoplasia?

Answer 1

Presence of atypical cells in vulval epithelium

Question 2

Outline the classifications of VIN

Answer 2

• Usual type VIN
• Differentiated type VIN

Question 3

Outline Usual Type VIN

• Types
• Age affected
• Associations
• Appearance

Answer 3

• Warty/ basaloid/ mixed
• 35-55yrs
• Associated with;
  
  • HPV-16
  • CIN
  • Smoking
  • Immunosuppression
• Appearances vary

Question 4

Outline Differentiated type VIN

• Is this more common than Usual Type?
• Associations
• Appearance

Answer 4

• Rarer than usual type
• Associated with;
  
  • Lichen sclerosis
  • Older women
  • Linked to keratinizing squamous cell carcinoma of vulva
• Appears as unifocal ulcer/ plaque

Question 5

Outline the clinical presentation of VIN & treatments

Answer 5

• Pruritis/ pain common
• Treatments
  
  • Emollients/ steroid creams
  • Local surgical excision if gold standard

Question 6

Outline the epidemiology of Vulval Carcinoma

Answer 6

• Most common after 60yrs
• 5% of genital tract cancers

Question 7

Outline the Pathology of Vulval Carcinoma

Answer 7

• Squamous Cell Carcinoma (95%)
• Melanomas
• Basal cell carcinomas
• Adenocarcinomas
• • Others [eg Sarcomas]

Question 8

Outline the Aetiology of Vulval Carcinoma

Answer 8

• VIN is premalignant stage of squamous carcinoma
• de novo
• Associated with;
  
  • Lichen sclerosis
  • Immunosuppresssion
  • Smoking
  • Paget’s disease of the vulva

Question 9

Outline the clinical presentation of Vulval Carcinoma

Answer 9

• Pruritis/ bleeding/ discharge/ mass
• Often unnoticed
• O/E
  
  • Ulcer/ mass on labia majora/ clitoris
  • Lymphadenopathy

Question 10

Outline the Spread & Staging of Vulval Carcinoma

Answer 10

50% present with Stage 1.

1. Vulva/ perineum
   
   • **​(a) **<2cm stromal invasion
   • (b) >2cm stromal invasion
2. Adjacent spread (urethra/ vagina/ anus)
3. +Inguinofemoral nodes
4. Anywhere else: Upper urethra/ vagina/ rectum/ bladder/ bone/ mets

Question 11

Outline the investigations for Vulval Carcinoma

Answer 11

• Biopsy: diagnosis + histological type
• Fitness for surgery

Question 12

Outline the treatment for Vulval Carcinoma

Answer 12

1. (a)

• Wide local excision (WLE)

1. (b) - 4.

• WLE + Groin Lymphadenectomy through ‘skin sparing’ incisions
• aka Triple incision radical vulvectomy

**Radiotherapy **to shrink prior to surgery