Revised November 2020

Vulvar Intraepithelial Neoplasia (VIN), is a precursor lesion in some cases:

VIN can be treated with wide local excision, and/or laser therapy. The use of topical imiquimod has also shown good response rates in women with usual type VIN. 

There is no screening program for vulvar cancer. However, due to similar risk factors, women with a past history of HPV related cervical or vaginal cancer should have a careful inspection of their vulva as part of their regular follow-up. Women with lichen sclerosis, or with a past history of VIN should also have routine surveillance.

Vulvar cancer can be asymptomatic, but the majority of patients present with a vulvar lump or a vulvar ulcer.  There is often pain associated with the lesion, along with a long-standing history of vulvar pruritus, bleeding or discharge. Most squamous cell carcinomas of the vulva occur on the labia majora, but the labia minora, clitoris, and perineum may also be primary sites.  Advanced cases may present with an enlarged inguinofemoral node. 

The diagnosis needs to be confirmed with a biopsy prior to definitive management. The biopsy should include underlying stroma in order to assess for the depth of invasion. An office wedge or Keyes punch biopsy is usually sufficient. 

Preferably, the entirety of the lesion should not be excised in order to obtain a tissue diagnosis, as this can make it challenging to plan the definitive excision.