Area of Science:

• Gynecologic Oncology
• Dermatology
• Oncology

Context:

• Vulvar malignancies represent the fourth most frequent group of gynecologic cancers.
• While predominantly affecting older women, all histological subtypes can occur in women under 30.
• Diagnosis is frequently delayed, highlighting the need for improved awareness and diagnostic strategies.

Purpose:

• To provide an overview of vulvar malignancies, including incidence, histology, and diagnostic considerations.
• To discuss the importance of biopsy mapping in determining surgical approach based on tumor location and histology.
• To review current evidence regarding treatment options, including excision, and the potential role of checkpoint inhibitors and targeted therapies, particularly for vulvar melanoma.

Summary:

• Squamous cell carcinoma is the most common type (over 76%), with vulvar intraepithelial neoplasia (VIN) as a precursor. Basal cell carcinoma is the second most frequent.
• Vulvar melanoma accounts for 5.7% and has a poorer prognosis than cutaneous melanoma. Evidence for systemic therapies in vulvar melanoma is discussed.
• Excision is the primary treatment for resectable tumors. Management in specialized centers is crucial for optimal disease control and preservation of function.

Impact:

• Emphasizes the need for interdisciplinary collaboration between dermatologists and gynecologic oncologists for optimal diagnosis and treatment.
• Highlights the importance of specialized centers for managing rare vulvar cancers to ensure best possible outcomes.
• Aims to improve patient care by discussing current evidence and treatment strategies for vulvar malignancies, including rare subtypes and advanced therapies.