Vulvar Malignant Neoplasms

Frankie Lambert and Dr. Mary Gail Mercurio discuss vulvar malignant neoplasms, specifically squamous cell carcinoma (SCC) and its precursors, melanoma, and extramammary Paget's disease (EMPD). They note that vulvar cancers account for only 5% of gynecologic malignancies, with SCC being the most common type. They clarify recent changes in nomenclature relating to precursor lesions, defining low-grade squamous intraepithelial lesions (LSIL) as associated with low-risk HPV and high-grade lesions (HSIL) linked to high-risk HPV with a higher malignant transformation risk. Two distinct pathways for SCC development are emphasized: the HPV-dependent pathway affecting younger women and the HPV-independent pathway affecting older women, which tends to be more aggressive. The presentation details diagnostic and treatment approaches for these conditions, advocating for a multidisciplinary approach. They discuss the implications of chronic inflammatory skin diseases like lichen sclerosus, which double the risk of malignant transformation. The importance of early detection and treatment options like topical therapies (e.g., Imiquimod) or surgical interventions is also highlighted. For melanoma, which comprises about 10% of vulvar cancers, the prognosis is generally poorer than that of cutaneous melanoma, emphasizing the need for careful monitoring. Lastly, the speakers address EMPD, noting its frequent presentation in apocrine-rich areas and the challenges in diagnosis and treatment, recommending a combination of topical and surgical approaches to effectively manage this condition.