AKT · Obstetrics & gynaecology/Gynae oncology & screeninglow yield

Vulval cancer

Vulval squamous cell carcinoma (HPV or lichen sclerosus related)

Overview

An uncommon malignancy, mostly squamous cell, of older women — arising from HPV-related VIN or from chronic lichen sclerosus. Presents with a persistent vulval lump, ulcer or itch.

Recognise

Persistent vulval lump, ulcer or plaque; itch, pain, bleeding
Often on labia majora
Background of lichen sclerosus or VIN

Red flags

Any persistent vulval lump/ulcer → biopsy (do not treat as infection indefinitely)

Differentials & how to tell them apart

Lichen sclerosuswhite atrophic itch — but can be the precursor; biopsy non-resolving areas

Vulval intraepithelial neoplasia (VIN)pre-malignant, biopsy

Bartholin cyst/abscesscystic, at gland site

Genital wartssoft papillomatous, HPV 6/11

Investigations

Biopsy of any suspicious lesion. Examine groin nodes; MRI/CT for staging.

Management

Wide local excision (± groin lymphadenectomy)

1Biopsy any persistent vulval lesion. Surgery: wide local excision ± inguinofemoral lymphadenectomy.
2Advanced: radiotherapy/chemoradiation; treat background lichen sclerosus/VIN.

Wide local excision ± lymphadenectomy — surgical mainstay

Radiotherapy/chemoradiation — advanced

Key points

Persistent vulval symptoms attributed to "thrush" without examination is a classic miss — biopsy non-resolving lesions.

Monitor & prognosis

Recurrence; treat background dermatosis.

Good if early and node-negative.

Source: NICE NG12; BGCS