Vulvar cancer accounts for 5% of gynecologic malignancies and occurs most commonly in postmenopausal women. Many vulvar neoplasms are asymptomatic and are discovered incidentally during gynecologic examination. Patients with symptoms most commonly complain of vulvar pruritis and may have noticed a vulvar mass. In advanced cases, vulvar bleeding or discharge, dysuria, or inguinal lymphadenopathy may be present. A single plaque, ulcer, or mass (fleshy, nodular, or warty) is most commonly found on the labia majora, but other areas may be affected. Less than 5% of cases have multifocal lesions.
Squamous cell carcinomas account for 90% of vulvar cancers, whereas melanoma is the second most common type. Risk factors include smoking, chronic inflammatory conditions such as LS, and infection with HPV 16, 18, or 33.
Management and Disposition
No treatment is necessary in the ED. Refer all patients with suspicious vulvar lesions for outpatient gynecologic evaluation. Definitive diagnosis is made by biopsy.
Coexisting cervical neoplasia is found in more than 20% of patients with a vulvar malignancy.
Vulvar Melanoma. A melanoma is seen in the proximal vaginal mucosa. (Photo contributor: Loyd A. West, MD.)
Squamous Cell Carcinoma. An area of lichenification, with an ulcerated erythematous lesion at the 6-o’clock position on the vaginal introitus is seen. (Photo contributor: Loyd A. West, MD.)
Squamous Cell Carcinoma. A large erythematous ulceration in the midportion of the left labia majora is seen. An area of invasive cancer is seen at the superior margin of the labia majora. (Photo contributor: Loyd A. West, MD.)