Invasive vulvar tumors in young women--a disease of the immunosuppressed?

Twenty-seven patients under the age of 40 years were treated for invasive vulvar cancer at the Women's Cancer Center, University of Minnesota. Seventeen patients had Stage I, five patients had Stage II, two patients had Stage III, and two patients had Stage IV disease. Twenty patients (80%) gave a history of smoking. Associated medical and immunosuppressive conditions present in these patients included vulval HPV (N = 3), diabetes mellitus (N = 3), pregnancy (N = 2), autoimmune connective tissue disease (N = 2), renal transplant (N = 2), previous chemotherapy for invasive malignancies at other sites (N = 1), chronic hepatitis (N = 1), schizophrenia (N = 1), and one patient on Imuran for herpes zoster and multiple sclerosis. Two of the nonsmokers were in this group of immunosuppressed patients. Three patients have died of intercurrent disease while another is currently alive with invasive disease. All others are alive without evidence of disease. The mean duration of follow-up is 45.2 months (range, 1-158 months). Invasive vulvar tumors are uncommon in young women. Smoking and a history of an immunosuppressive medical illness is common in this patient population.