Vulvar carcinoma

Carcinoma of the vulva is an uncommon gynecologic malignancy primarily affecting postmenopausal women. The lesion is most commonly associated with HPV DNA, although, for many, a defined preinvasive to invasive connection is not readily apparent. Most patients experience symptoms of pruritus, irritation, and even pain for weeks or months before the diagnostic biopsy is performed. Patient embarrassment and unfamiliarity and reluctance on the part of the physician to fully evaluate these symptoms add to the delay. Vulvar carcinoma is staged surgically following resection. A concerted effort to conserve as much normal tissue as possible has been the focus of recent investigation. Separate incision resection of the vulvar mass and groin has improved wound healing and quality of life for many patients. The effect these conservative procedures have on long-term survival is currently being evaluated. Increased use of radiation therapy or chemoradiation has allowed organ preservation in many otherwise exenterative cases. In some instances, this neoadjuvant therapy has provided an opportunity to surgically clear otherwise unresectable lesions. Current radiotherapy techniques might also be as effective as groin dissection in certain low-risk patients. Adjuvant radiation and chemoradiation improve local control and reduce groin recurrence risk. In addition, patients with histologically positive groins enjoy longer survival when the pelvis is also treated. Selected use of multimodality therapy will likely extend the lives of women with vulvar cancer.