Carcinoma of the Vulva

Incidence:

Vulva carcinoma is an uncommon disease usually confined to elderly women.

Aetiology:

The vulva is an ideal site for skin irritation-warm and moist, prone to friction, poor hygiene and scratching.

Pathology:

Carcinoma of the vulva is usually a slow growing and well-differentiated squamous carcinoma. Most of the lymphatics drain directly to the superficial and deep inguinal nodes, and then to the iliac chain.

Clinical Features:

The woman usually presents with a history of chronic vulval irritation. She may have delayed seeking advice owing to embarrassment. The lesion is usually an epitheliomatous ulcer but sometimes may be in a ‘cauliflower’ form. The surrounding epithelium may show features of an underlying vulval dystrophy.

Management:

All suspicious lesions must be biopsied. If vulval intraepithelial neoplasia is diagnosed, excision may be appropriate. Invasive carcinoma is best managed by radical vulvectomy which consists of excision of the vulva and removal of the inguinal and femoral lymph nodes using separate groin incisions for the lymphadenectomy as opposed to an enblock removal as in. This does not compromise the success of the operation and reduces morbidity associated with poor wound healing. Complications include lymphocoele formation at the groin as a consequence of node dissection and these usually resolve with intermittent drainage. Lymphoedema can be a chronic complication.

Complications:

The morbility and mortality from the operation are high, but the alternative is an unpleasant demise from a foul, fungating and painful growth.