Vulvar Cancer

Vulvar cancer is the fourth most common gynecologic cancer, most frequently diagnosed in postmenopausal women. There are two independent pathways for the most common type of vulvar cancer, squamous cell carcinoma (SCC). The warty type of vulvar SCC is usually preceded by the typical vulvar intraepithelial neoplasia (VIN), with integrated human papillomavirus. In contrast, well-differentiated keratinizing vulvar SCC is preceded by differentiated VIN and chronic inflammation. Preinvasive (VIN) lesions are usually surgically excised or ablated with laser or chemical destruction. Early-stage (stage I/II) invasive squamous cell vulvar carcinoma is surgically staged and treated with a lymph node sampling/dissection and a radical wide local excision. Treatment of advanced-stage disease (III/IV) is individualized, depending on the size, location, and lymph node status. The survival of patients with vulvar cancer correlates with the stage of the disease, with lymph node status being the single most important prognostic factor.