Vulval squamous cell carcinoma: a review

Area of Science:

• Oncology
• Gynaecology
• Dermatology

Background:

• Vulval squamous cell carcinoma (VSCC) accounts for 90% of vulval cancers.
• Incidence is rising globally, with highest rates in Western Europe, North America, and Northern Europe.
• Two distinct etiological pathways exist: HPV-dependent and HPV-independent.

Purpose of the Study:

• To provide a comprehensive overview of current evidence on VSCC epidemiology, clinical features, diagnosis, and management.
• To highlight recent refinements in national guidelines for VSCC.
• To discuss the impact of the HPV vaccine on VSCC incidence.

Main Methods:

• Review of current epidemiological and clinical evidence.
• Analysis of diagnostic workup including clinical history, examination, vulvoscopy, and biopsies.
• Examination of treatment modalities including surgical excision, chemoradiotherapy, and immunotherapy.

Main Results:

• VSCC presents with a suspicious vulval lesion, but early symptoms can be non-specific, causing diagnostic delays.
• Prognosis is stage-dependent, with 5-year survival dropping significantly from early to late stages.
• The HPV vaccine represents a potential intervention to impact future VSCC incidence.

Conclusions:

• VSCC pathogenesis involves HPV infection or chronic inflammatory dermatoses.
• Timely diagnosis and appropriate treatment based on FIGO staging are critical for patient outcomes.
• The HPV vaccine holds promise for reducing the future incidence of VSCC.