There is no screening test.
Diagnosis. All vulvar lesions of uncertain etiology should be biopsied. Patients
with vulvar pruritus should be considered for the possibility of preinvasive or
invasive vulvar carcinomas if there is a vulvar lesion. A biopsy of this patient’s
lesion reveals invasive squamous cell carcinoma of the vulva.
Pattern of spread starts with local growth and extension that embolizes to
inguinal lymph nodes, and then sees hematogenous spread to distant sites.
Staging. Staging is surgical and utilizes the TNM (tumor, nodes, metastasis)
classification. Stage 1 is the most common stage.
Squamous cell (90%). The most common type of invasive vulvar cancer is
squamous cell carcinoma, which has been associated with HPV. Pathogenesis
is chronic inflammation (for older women) and HPV infection (for younger
women). The most common stage at diagnosis is stage 1.
Melanoma (5%). The second most common histologic type of vulvar cancer
is melanoma of the vulva, and the most important prognostic factor for this
type of tumor is the depth of invasion. Any dark or black lesion in the vulva
should be biopsied and considered for melanoma.
Paget's disease. An uncommon histologic lesion is Paget's disease of the
vulva. Paget's disease is characteristically a red lesion, which is most
common in postmenopausal white women. Any patient with a red vulvar
lesion must be considered for the possibility of Paget's disease. Most of the
time Paget's disease is an intraepithelial process; however, in approximately
18–20% of cases invasion of the basement membrane has been identified.
Patients with Paget's disease of the vulva have a higher association of other
cancers mainly from the GI tract, the genitourinary system, and breast.