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  • Presentation

Malignant Vulvar Neoplasms

Description

In this session on malignant vulvar neoplasms, Frankie Lambert and Dr. Miguel Mercurio detailed the distinct pathways of squamous cell carcinoma (SCC), emphasizing that HPV-related cancers primarily affect younger women, while HPV-independent cancers often arise from inflammatory conditions like lichen sclerosis and typically affect older women. HPV plays a significant role in these cancers, with HPV vaccines like Gardasil 9 being imperative for prevention. They highlighted the treatment options and importance of surveillance in patients with lichen sclerosis, noting the high risk of SCC among those who are poorly managed. The discussion also addressed treating invasive squamous cell carcinoma and emphasized the importance of surgical intervention and multidisciplinary approaches for management. Additionally, they touched upon vulvar melanoma, detailing its poorer prognosis compared to cutaneous melanoma, and the challenges with screening and biopsy, especially in older women. Finally, the session emphasized the psychosocial and sexual implications of these cancers, advocating for early diagnosis and comprehensive care.

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Conclusions

  • Malignant vulvar neoplasms can be classified into two main pathways: HPV-dependent and HPV-independent, each with different characteristics and survival rates.
  • Women with HPV-positive vulvar neoplasms generally have a better disease-specific survival compared to those with HPV-negative neoplasms, which are often associated with chronic inflammatory conditions.
  • The HPV vaccine is highly effective, but uptake remains problematic, particularly among boys, which affects herd immunity and the overall prevention of HPV-related cancers.
  • Regular screening and treatment of precursors such as lichen sclerosus is crucial to reduce the risk of malignant transformation to squamous cell carcinoma.
  • Immunosuppression and other cofactors, such as smoking and number of sexual partners, increase the risk for young women developing HPV-related vulvar cancers.
  • Monitoring and surveillance after treatment of squamous cell carcinoma in situ (HSIL) are critical, as these lesions can recur even after successful treatment.
  • Surgical management options include Mohs surgery, which may be beneficial for specific cases and must be a collaborative effort involving gynecologic oncologists and dermatologists.
  • Long-term follow-up is essential for all patients with vulvar lesions due to the risk of recurrence and related morbidity from cancer treatment.
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