Gynecology [VULVAR / VAGINAL CANCER]

Vulvar Cancer
While the most common type (squamous cell carcinoma)
follows the same pathogenesis as cervical cancer (HPV
exposure), there are two kinds of vulvar cancer that are a bit Pruritus
different. The diagnosis and treatment of SCC of the vulva is Asx Pelvic
identical to melanoma - both tend to metastasize. Here’s a brief
review of melanoma and Paget’s disease.
1. Melanoma presents as a black lesion in rather sun un-
exposed areas. If a lesion is found it gets biopsied.
Because of its tendency to metastasize and its general Inspection
resistance to chemotherapy (see surgery videos), it’s
essential to perform a vulvectomy and inguinal lymph
nodectomy. This results in sexual dysfunction and lower
leg lymphedema. Biopsy
2. Paget’s disease is a red lesion that’s usually confined to
the epithelium (that is, not invasive). After a biopsy to
diagnose, local resection is usually curative.

Paget’s Melanoma SCC

All vulvar cancers present with pruritis. If there’s a lesion do a
biopsy and treat the tumor with some sort of resection. Note that Local Resection Vulvectomy and Vulvectomy and
Paget’s disease of the breast portends a terrible diagnosis, while LN Dissection LN Dissection
Paget’s disease of the vulva is often benign.

High grade VIN (not cancer yet) can involve topical treatments,
laser ablations, or surgery, usually with minimal loss to overlying
tissue.
Paget’s
SCC
Invasive cancers will have more radical resections (vulvectomy)
and regional lymph node assessments.
Melanoma
For cancer get a biopsy and resection. Recognize the black one
(melanoma), the red one (Paget’s) and the other one (SCC).

Vaginal Cancer
While the most common type (again squamous cell carcinoma)
follows the identical pathogenesis to cervical cancer (HPV
exposure) you must also know about clear cell adenocarcinoma
and DES exposure. If adenocarcinoma is ever found, look for a
history of DES use in the woman’s mother while she was
pregnant with this current patient. Since DES hasn’t been used for
50 years this is getting rarer and rarer, but it’s a good board/pimp
question. This, not to be confused with a molar pregnancy, will
be described as a grape-like lesion protruding through the
vaginal opening.

Not surprisingly, you’ll be able to see the cancers on exam (using

a Lugol’s solution); a biopsy will give the diagnosis. Resect
vaginal cancers.

Cancer Lesion Diagnosis Symptoms Treatment

SCC Black Lesion Biopsy Pruritis Vulvectomy and lymph node dissection
Vulvar Melanoma Black Lesion Biopsy Pruritis Vulvectomy and lymph node dissection
Paget’s Red Lesion Biopsy Pruritis Local Resection

Vaginal SCC HPV
Adenocarcinoma DES


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