Vulval cancer
Malignancy of the vulva, most often a squamous cell carcinoma arising either from HPV-related intraepithelial neoplasia in younger women or from long-standing lichen sclerosus in older women; it presents with a vulval lump, ulcer, persistent itch or bleeding, and delayed presentation is common because women do not report symptoms.
Definition
Vulval cancer is a malignant tumour of the vulva, most commonly squamous cell carcinoma (with rarer melanoma, basal cell carcinoma and adenocarcinoma). Squamous carcinoma arises either from usual-type (HPV-related) vulval intraepithelial neoplasia or from differentiated vulval intraepithelial neoplasia in a background of lichen sclerosus.
First principles
Two routes to a squamous cancer
Most vulval cancers are squamous cell carcinomas. An HPV-associated pathway is linked to usual-type vulval intraepithelial neoplasia and is more common in younger people; an HPV-independent pathway is associated with differentiated VIN and chronic vulval dermatoses such as lichen sclerosus, and is more common in older people. The pathways can overlap clinically, so histology and specialist pathology are required.
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