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Vulvar & Vaginal Cancer Digest

The Month in Vaginal & Vulvar Cancer Research

This Month in Vaginal Cancer Research

The open-access literature that is available on vaginal cancer research this month comes from adjacent areas: research on HPV persistence, cervical precancer treatment, and vaginal health in cancer survivors. These topics are closely connected to vaginal cancer's roots, as most vaginal cancers are driven by HPV infection, and the findings have real relevance for this community even if they don't study vaginal cancer directly.

 

The papers highlighted here represent a selection of those published during the month. The papers were selected and summarized by AI. Accuracy of the summaries was confirmed by a scientist. This digest incorporates only open-access research articles that are free to be read by the entire community and that are explicitly licensed to be shared and reused.

A new self-administered treatment for cervical precancers is acceptable to patients and could one day expand options for vaginal precancers too

Vaginal intraepithelial neoplasia (VaIN, abnormal cell changes in the vaginal lining that can progress to invasive vaginal cancer if left untreated) shares its main cause with cervical precancers: persistent infection with high-risk strains of HPV. Treatments that work for cervical precancers are often candidates for VaIN as well. A new qualitative study followed 17 women in western Kenya who participated in a Phase 1 trial of intravaginal artesunate, a self-administered medication that may treat cervical and vaginal precancerous changes (CIN 2/3) without surgery.

  • Despite having little prior experience with self-administered vaginal medications, the women in this study found the artesunate pessary, a small, suppository-like insert, highly acceptable. Most used it at home without difficulty, appreciated its discreet nature, and felt motivated by the chance to treat their precancer with something less invasive than surgical options like LEEP (loop electrosurgical excision procedure). Social support, education from the research team, and trust in the clinical process were all important to completing treatment successfully. The researchers found that cost remains a significant barrier to standard cervical precancer treatment for women in low-resource settings, making affordable, self-administered therapies particularly meaningful. Randomized trials to test whether artesunate actually clears precancerous lesions are still needed. (Read the full paper)

HPV infection is the root cause of most vaginal cancers, and new research is clarifying why it persists in some people and clears in others

Understanding HPV persistence matters for vaginal cancer prevention because people who clear high-risk HPV rarely develop vaginal or cervical cancer, while those who carry it long-term are at significantly higher risk.

  • A review published this month examined how the vaginal and gut microbiome, mitochondrial function, and tiny cellular messengers called extracellular vesicles work together to either help the immune system clear HPV or allow it to persist. When the vaginal microbiome is out of balance, a state called dysbiosis, the immune response weakens, and HPV is more likely to take hold and remain. Mitochondrial disruption plays a role too, interfering with the body's antiviral signaling systems. While this research is primarily preclinical and translational (meaning it's about understanding mechanisms rather than immediate treatment applications), it points toward new potential targets for therapies that could help clear persistent infections before they progress to cancer. (Read the full paper)
  • A related systematic review of HPV data from Eastern Europe added important context: HPV types 16 and 18, the highest-risk strains targeted by current vaccines, dominate infections in that region, but a substantial share of infections involve other high-risk types like HPV 31, 51, 52, and 66 that are not covered by older bivalent or quadrivalent vaccines. The 9-valent HPV vaccine covers more of these genotypes. The review also highlighted that vaginal microbiome composition and dysbiosis are increasingly recognized as factors in cervical cancer risk, a connection that likely extends to vaginal cancer, which shares the same HPV-driven biology. (Read the full paper)

Treatment-related vaginal and sexual health changes are common and undertreated, and patients and care teams need better tools to address them

While this month's study focused on breast cancer patients, its findings reflect a challenge that applies directly to people treated for vaginal cancer and other gynecologic cancers.

  • A prospective study protocol published this month describes an ongoing study following over 100 premenopausal women with breast cancer receiving hormone-suppressing endocrine therapy, tracking how their vaginal microbiome changes over a year and how those changes relate to vaginal dryness, pain, and other symptoms of genitourinary syndrome of menopause. Endocrine therapy-induced estrogen suppression can cause substantial vaginal changes, and this study aims to understand whether microbiome shifts are part of the mechanism. This is a study protocol (meaning results are not yet available), but the approach it's testing — connecting vaginal microbiology to patient-reported symptoms — is exactly the kind of personalized framework that people with vaginal cancer and their care teams need. (Read the full paper)

What Does This Mean for Me?

If you've been diagnosed with vaginal cancer or are managing VaIN, the most clinically significant papers on vaginal cancer published in June 2026 (including new data on image-guided brachytherapy for vaginal recurrences and a case review of rare vaginal sarcomas) are listed in the licensing section below, with links to their DOI pages where you can read or share them with your care team. Don't let the licensing restrictions in this digest be a gap in your own access to information.

For anyone managing long-term effects of cancer treatment, the consistent message across multiple studies this month is that vaginal and sexual health changes are extremely common after treatment and extremely undertreated. If you're experiencing dryness, pain, or changes to sexual function after treatment for vaginal cancer or any gynecologic cancer, these are not things you should feel you have to accept silently. They're treatable. Ask your care team directly about pelvic floor physical therapy, vaginal moisturizers, topical treatments, and sexual health referrals.

On HPV vaccination, the research this month adds to an already robust case: the 9-valent HPV vaccine offers meaningfully broader protection than older versions. If there are young people in your life who haven't been vaccinated, or who received an older vaccine formulation, that conversation is worth having with their healthcare provider.

Progress in rare cancers depends on the people willing to participate in research — through clinical trials, registries, and advocacy. If you're interested in contributing, visit ocrahope.org to learn more about OCRA's research programs and community resources, or ask your care team about open studies.

 

This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.

Sources

Directly Referenced in This Digest

  1. Sadana A, et al. "'When a Thorn Comes Into Your Body, You Must Remove It'. A Socio-Ecological Analysis of the Acceptability of Intravaginal Artesunate as Cervical Precancer Treatment in a Phase 1 Clinical Trial." International Journal of Women's Health. June 29, 2026. PMID 42403515. https://doi.org/10.2147/IJWH.S573262
  2. Moustakli E, et al. "The Microbiome-Mitochondria-Extracellular Vesicle Axis in HPV Persistence and Cervical Carcinogenesis." Genes (Basel). June 1, 2026. PMID 42353813. https://doi.org/10.3390/genes17060655
  3. Radu EA, et al. "Beyond HPV in Eastern Europe: Genotype Distribution, Molecular Biomarkers, Vaginal Microbiome, and Implications for Cervical Cancer Prevention." Life (Basel). June 22, 2026. PMID 42355563. https://doi.org/10.3390/life16061039
  4. Chen F, et al. "Vaginal microbiota and genitourinary syndrome of menopause in premenopausal breast cancer patients receiving endocrine therapy: a longitudinal cohort study protocol." Frontiers in Medicine. June 15, 2026. PMID 42375202. https://doi.org/10.3389/fmed.2026.1826064

Additional Open-Access Papers Published in June 2026 on Related Topics

All open-access papers published in June 2026 on vaginal cancer and directly related topics with confirmed permitted licenses are referenced in the digest above.

Papers Excluded Due to Licensing Restrictions

  1. Lancellotta V, et al. "Image-guided adaptive interventional radiotherapy (modern brachytherapy) boost for vaginal recurrences." La Radiologia Medica. June 20, 2026. PMID 42322514. https://doi.org/10.1007/s11547-026-02235-8 (Excluded: open-access license not confirmed per-article; La Radiologia Medica uses CC BY or CC BY-NC-ND depending on article. Topic: retrospective study of 32 patients with vaginal cuff recurrences treated with image-guided brachytherapy boost following external beam radiation; 2-year local control rate of 100%, with favorable toxicity profile. High clinical relevance.)
  2. Hornbach AC, et al. "Primary pelvic extraskeletal Ewing sarcoma: a case report and comprehensive literature review of molecularly confirmed cases arising within the female genital tract." Gynecologic Oncology Reports. June 17, 2026. PMID 42383151. https://doi.org/10.1016/j.gore.2026.102147 (Excluded: per-article license not confirmed; Gynecologic Oncology Reports uses CC BY, CC BY-NC, or CC BY-NC-ND depending on article. Topic: case report of a 21-year-old with Ewing sarcoma involving the uterus, vagina, and bladder, plus a literature review of 98 molecularly confirmed cases of Ewing sarcoma arising in gynecologic organs including the vagina.)
  3. He R, et al. "5-Aminolevulinic Acid Photodynamic Therapy for Non-Lesional Persistent High-Risk HPV Infection: A Comparative Cohort Study With Interferon." International Journal of Cancer. June 22, 2026. PMID 42332975. https://doi.org/10.1002/ijc.70625 (Excluded: UICC copyright, subscription journal. Topic: comparison of ALA-PDT versus interferon for clearing persistent high-risk HPV infection in cervical patients without visible lesions; PDT showed substantially higher clearance rates.)
  4. Seksaf NA, et al. "Quality of Life Outcomes Following Pelvic Exenteration for Gynaecological Malignancies: A Systematic Review." Anticancer Research. June 2026. PMID 42203329. https://doi.org/10.21873/anticanres.18172 (Excluded: All rights reserved, proprietary publisher license. Topic: systematic review of 23 studies on quality of life after pelvic exenteration — a radical surgical procedure used for advanced or recurrent gynecologic cancers including vaginal cancer — finding that global QoL may recover over time but sexual function, body image, and psychological distress show persistent morbidity.)
  5. Yang K, et al. "Contrast-enhanced MRI improves the diagnostic performance for vaginal fornix invasion in cervical carcinoma." Insights into Imaging. June 4, 2026. PMID 42243469. https://doi.org/10.1186/s13244-026-02326-0 (Excluded: open-access license not confirmed per-article. Topic: study of 149 cervical cancer patients showing that adding contrast-enhanced MRI to standard T2-weighted and diffusion-weighted imaging significantly improves accuracy for detecting vaginal fornix invasion, with implications for staging and surgical planning.)
  6. Schröder C, et al. "Vaginal cuff dehiscence and bowel evisceration as a late-onset complication of vaginal vault prolapse: a case report." Journal of Medical Case Reports. June 13, 2026. PMID 42286745. https://doi.org/10.1186/s13256-026-06214-5 (Excluded: open-access license not confirmed per-article. Topic: case report describing vaginal cuff dehiscence in a patient on anti-HER2 and antihormonal breast cancer therapy, raising a hypothesis about potential association between this targeted therapy and impaired tissue healing.)

 This Month in Vulvar Cancer Research

Vulvar cancer accounts for roughly 5% of gynecologic cancer diagnoses, and the pace of research reflects that rarity; some months bring a rich spread of new evidence, others cluster tightly around a few themes. June 2026 was a month of genuine breadth: new data on chemoradiation, a landmark trial co-design process that puts patients at the center of surgical research, and an illustrative case report on reconstructive surgery after Vulvar Paget's disease.

 

The papers highlighted here represent a selection of those published during the month. The papers were selected and summarized by AI. Accuracy of the summaries was confirmed by a scientist. This digest incorporates only open-access research articles that are free to be read by the entire community and that are explicitly licensed to be shared and reused.

A tumor marker may help predict which patients with locally advanced vulvar cancer will respond to chemoradiation

For people with more advanced vulvar cancer that can't be managed with surgery alone, chemoradiation, a combination of radiation therapy and chemotherapy, is often used to shrink or eliminate the tumor. Not every patient responds equally, and researchers have been looking for ways to identify in advance whose cancer is most likely to respond.

  • A retrospective study from Rome looked at 61 patients with locally advanced vulvar squamous cell carcinoma who received chemoradiation between 2016 and 2024. The study evaluated whether a protein called p16(INK4a), a marker that signals whether a cancer is driven by HPV, the human papillomavirus, could predict treatment response and survival. Tumors that tested positive for p16 (indicating HPV involvement) had dramatically better outcomes: a complete response rate nearly seven times higher, and three-year survival rates more than three times better than p16-negative tumors. Importantly, p16 status was the only factor that independently predicted whether the cancer fully responded. Tumor size, lymph node involvement, and radiation dose did not add further predictive value. This finding, if confirmed in larger prospective studies, could help doctors and patients have better-informed conversations about what to expect from chemoradiation, and may eventually guide which patients should receive additional or alternative treatments. (Read the full paper)

Patients and researchers are working together to redesign how vulvar cancer surgery trials are built

The question of how aggressively to treat the lymph nodes in the groin is one of the most consequential decisions in vulvar cancer care. Standard surgery to remove multiple lymph nodes, called inguinofemoral lymphadenectomy, dramatically reduces the risk that cancer will spread, but it also carries a high risk of lymphedema, a chronic condition involving lasting swelling of the leg that can significantly affect daily life. An international phase 3 clinical trial called ANVU (Australian National Vulvar Cancer trial) is now testing whether serial ultrasound monitoring of the groin could safely replace upfront surgical lymph node removal in eligible patients.

  • A paper from the University of Queensland describes how the ANVU trial team held a structured co-design workshop with six people who had lived experience of vulvar cancer, including patients and one partner/carer, alongside the clinical research team. Rather than presenting a pre-determined outcome measure for patients to approve, the team genuinely built the trial's endpoints from the ground up with patient input. The results were revealing: in the short term, patients prioritized getting the cancer out completely, even at the cost of difficult recovery. But as time went on, their priorities shifted sharply toward quality of life, fear of recurrence, and, most strikingly, avoiding lymphedema. For some participants, the fear of chronic leg swelling outweighed the fear of the cancer itself. The trial's primary endpoint (survival following lymph node spread, measured at 30 months) and its secondary endpoints (quality of life, daily function, lymphedema, pain, and fear of recurrence) were shaped directly by these insights. This paper is not a clinical trial result; it describes the co-design process itself. But for anyone living with vulvar cancer, it's a meaningful sign that the research community is listening. (Read the full paper)

Reconstructive surgery after Vulvar Paget's disease: a case report on surgical planning using imaging technology

Vulvar Paget's disease, a rare, slow-growing skin cancer of the vulvar region, often requires wide surgical excision that leaves a significant tissue defect. Reconstructing the affected area is a complex challenge, and surgeons have used a technique called the anterolateral thigh (ALT) flap, where tissue and its blood supply are transferred from the upper thigh, to repair the surgical site. A key challenge is that the blood vessels supplying the flap vary considerably between patients.

  • A case report from a hospital in China describes a 68-year-old woman with extensive bilateral Vulvar Paget's disease who underwent radical vulvectomy followed by ALT flap reconstruction. Before surgery, the team used digital computed tomography angiography (CTA, a type of 3D imaging that maps the exact location, size, and path of blood vessels) to plan the flap precisely. The CTA allowed surgeons to identify the dominant supplying vessel in advance, avoiding the time-consuming and riskier process of exploring blood vessel anatomy during the surgery itself. One year after the procedure, the patient had normal urinary function, recovered sensation, and no recurrence. As with all case reports, the findings from a single patient can't be broadly generalized, but this case illustrates how digital surgical planning tools may improve the safety and precision of reconstructive procedures for people with Vulvar Paget's disease, which is a particularly meaningful concern given how much tissue these surgeries often remove. (Read the full paper)

What Does This Mean for Me?

If you or someone you care about has locally advanced vulvar cancer being treated with chemoradiation, it's worth asking your oncologist whether p16 testing has been performed on your tumor tissue, and what that result might mean for your expected treatment response. This research is still evolving, but p16 status is a simple immunohistochemical test that may already be part of your pathology workup. Understanding whether your cancer is HPV-related (p16-positive) may help you and your care team think through realistic expectations and next steps if chemoradiation doesn't produce a complete response.

If lymphedema is a concern for you, or if you're earlier in your treatment and worried about it becoming one, the ANVU trial described this month is one you may want to know about. It's asking directly whether some patients can safely avoid upfront groin lymph node surgery by being monitored with ultrasound instead. If you live in Australia or another country where the trial is enrolling internationally, it may be worth asking whether you might be eligible. More broadly, the co-design process behind this trial is a signal that the vulvar cancer research community is actively working to make treatment less burdensome, not just longer-surviving.

For anyone navigating Vulvar Paget's disease, reconstruction after surgery is a topic that deserves a detailed conversation with a surgeon experienced in both vulvar oncology and reconstructive techniques. The type of flap, the planning approach, and the surgeon's familiarity with these rare procedures all matter. Ask specifically about what reconstructive options are available and what follow-up care for both function and appearance typically looks like.

Because vulvar cancer is rare, clinical trials and patient registries are how progress happens. If you haven't already, visit ocrahope.org to learn about OCRA's research programs, patient resources, and how to get connected with the broader community. Participating in research makes a difference in a field where large studies are genuinely hard to conduct.

 

This digest is prepared by OCRA (Ovarian Cancer Research Alliance) for patients, caregivers, and advocates. It is intended to inform, not to guide individual treatment decisions. Please speak with your care team about what research findings may mean for your specific situation.

 

Sources

Directly Referenced in This Digest

  1. Federico A, et al. "p16(INK4a) immunohistochemical expression is a strong predictor of treatment response and survival in patients with locally advanced squamous cell vulvar cancer undergoing upfront chemoradiotherapy." Journal of Gynecologic Oncology. June 17, 2026. PMID 42363576. https://doi.org/10.3802/jgo.2026.37.e137
  2. Angel L, et al. "Co-designing primary and secondary outcome measures for an international phase 3 trial of surgical de-escalation in vulvar cancer through a consumer workshop." Research Involvement and Engagement. June 15, 2026. PMID 42298648. https://doi.org/10.1186/s40900-026-00902-8
  3. Bai Y, et al. "Case Report: Digital CTA-assisted anterolateral thigh perforator pedicled flap for repairing postoperative defects in Vulvar Paget's disease." Frontiers in Medicine. June 19, 2026. PMID 42404558. https://doi.org/10.3389/fmed.2026.1835423

Additional Open-Access Papers Published in June 2026 on Related Topics

All open-access papers published in June 2026 on vulvar cancer and related topics with permitted licenses are referenced in the digest above.

Papers Excluded Due to Licensing Restrictions

  1. Anjum R, et al. "Hidradenoma papilliferum presenting with acute vulvar pain and postcoital bleeding: a diagnostic pitfall." BMJ Case Reports. June 12, 2026. PMID 42285591. https://doi.org/10.1136/bcr-2026-273304 (Excluded: License not confirmed as permitted CC license; BMJ Case Reports defaults to proprietary licensing unless optional OA fee is paid, and copyright statement reads "No commercial re-use." Topic: Case report of a rare benign adnexal tumor, hidradenoma papilliferum, presenting with acute vulvar pain and postcoital bleeding, illustrating a diagnostic pitfall that can mimic more common vulvar lesions.)
  2. Nagao Y, et al. "Rapid Enlargement of Vulvar Glomus Tumor After Needle Aspiration and Tumor Base Ligation." The Journal of Obstetrics and Gynaecology Research. June 2026. PMID 42298747. https://doi.org/10.1111/jog.70373 (Excluded: License not confirmed per-article; Journal of Obstetrics and Gynaecology Research is a hybrid Wiley journal offering CC BY, CC BY-NC, or CC BY-NC-ND — specific article license could not be verified. Topic: Case report of a rare benign vulvar glomus tumor that rapidly enlarged after needle aspiration and ligation, suggesting the growth reflected vascular congestion and stromal edema rather than malignancy.)
  3. Morgenstern B, et al. "Dual Modality and Site-differentiated Sentinel Node Mapping in Vulvar Cancer." Anticancer Research. June 2026. PMID 42203323. https://doi.org/10.21873/anticanres.18209 (Excluded: "All rights reserved" proprietary license. Topic: Retrospective cohort study from Cologne demonstrating that sentinel lymph node identification using dual tracers — technetium and indocyanine green — is independent of injection site on the vulva, suggesting that sentinel node mapping can be performed after prior tumor removal.)
  4. Slyby JR, et al. "Melanoma presenting as a urethral caruncle." Menopause. June 1, 2026. PMID 41529138. https://doi.org/10.1097/GME.0000000000002719 (Excluded: "© 2026 by The Menopause Society" — proprietary license. Topic: Case report of a postmenopausal woman with malignant melanoma initially misidentified as a benign urethral caruncle, highlighting the importance of biopsy when such lesions do not respond to treatment.)
  5. Li MX, et al. "[Clinical analysis of 10 cases of gynecological malignancies complicated with paraneoplastic syndrome]." Zhonghua Fu Chan Ke Za Zhi. June 25, 2026. PMID 42373431. https://doi.org/10.3760/cma.j.cn112141-20260131-00083 (Excluded: License not confirmed; Chinese-language journal with no CC license metadata available. Topic: Retrospective analysis of 10 gynecological malignancy cases complicated by paraneoplastic syndrome, including one case of vulvar malignancy, examining clinical features, tumor types, and outcomes.)
  6. Chimiczewski W, et al. "Addressing lymphedema post gynecological cancer surgery: a public health imperative." Ginekologia Polska. June 9, 2026. PMID 42261735. https://doi.org/10.5603/gpl.112659 (Excluded: CC BY-NC-ND license. Topic: Retrospective study from Poland reporting lymphedema rates of 33% in vulvar cancer patients following surgery, with fewer than half receiving targeted treatment, highlighting gaps in post-surgical lymphedema management.)
  7. Alzayadneh E, et al. "PRAME Expression in HPV-associated and Differentiated Vulvar Intraepithelial Neoplasia-associated Vulvar Squamous Neoplasia." International Journal of Gynecological Pathology. June 8, 2026. PMID 42259311. https://doi.org/10.1097/PGP.0000000000001196 (Excluded: "© 2026 by the International Society of Gynecological Pathologists" — proprietary license. Topic: Study of 106 vulvar squamous neoplasms showing that the PRAME protein — a target for emerging immunotherapy — is most highly expressed in the differentiated (lichen sclerosus–related) pathway of vulvar cancer, suggesting this subtype may be a promising candidate for PRAME-targeted treatment.)
  8. Xie P, et al. "First-in-human evidence of multidrug resistance reversal in solid tumors: a cohort analysis of carbon nanoparticles-Fe(II) complex trials." BMC Cancer. June 5, 2026. PMID 42249319. https://doi.org/10.1186/s12885-026-16216-7 (Excluded: License not confirmed per-article; BMC Cancer uses either CC BY or CC BY-NC-ND and per-article license could not be verified. Topic: Phase I trial cohort analysis of a carbon nanoparticle-iron complex injected directly into tumors, with one patient with a rare myoepithelioma-like tumor of the vulvar region among four patients who achieved long-term survival and restored sensitivity to chemotherapy.)
  9. Penny CL, et al. "Racial Disparities in Cutaneous Melanoma Mortality: A Systematic Review and Meta-Analysis." Journal of Racial and Ethnic Health Disparities. June 24, 2026. PMID 42340645. https://doi.org/10.1007/s40615-026-03065-0 (Excluded: License not confirmed; Springer journal with no CC license metadata available. Topic: Systematic review and meta-analysis finding that Black and Asian/Pacific Islander patients with melanoma — including vulvar melanoma in the study scope — had 31% higher mortality risk than white patients, underscoring persistent racial disparities in melanoma outcomes.)
  10. Steinback G, et al. "Extramammary Paget Disease: A Single-Center, Clinical Analysis." Dermatologic Surgery. June 29, 2026. PMID 42360711. https://doi.org/10.1097/DSS.0000000000005237 (Excluded: "All rights reserved" — Wolters Kluwer proprietary license. Topic: Retrospective review of 80 patients with extramammary Paget disease, finding that the vulva was the most common site, that nearly 95% of vulvar cases had positive surgical margins, and that vulvar Paget disease had the highest local recurrence rate — while perianal and penoscrotal cases were more likely to metastasize.)
  11. Fukuda K, et al. "Collision Tumor of Basal Cell Carcinoma and Primary Extramammary Paget Disease: A Case Report and Literature Review." The American Journal of Dermatopathology. June 24, 2026. PMID 42333518. https://doi.org/10.1097/DAD.0000000000003368 (Excluded: "All rights reserved" — Wolters Kluwer proprietary license. Topic: Case report of a rare "collision tumor" in which basal cell carcinoma and extramammary Paget disease were found together in the same vulvar lesion, highlighting the diagnostic challenge of distinguishing these two distinct conditions when they overlap.)
  12. Tran HTT, et al. "Delayed Surgical Treatment Is Associated with Positive Margins and Worse Long-Term Survival in Early-Stage Vulvar Melanoma: A Retrospective National Cancer Database Study." Journal of the American Academy of Dermatology. June 10, 2026. PMID 42270047. https://doi.org/10.1016/j.jaad.2026.06.031 (Excluded: License not confirmed; JAAD is a subscription-based journal with no CC license metadata available. Topic: National Cancer Database study finding that delays in surgical treatment for early-stage vulvar melanoma were associated with a greater likelihood of positive surgical margins and worse long-term survival.)
  13. Burk JL, et al. "Cervicovaginal cytologic features in patients with Vulvar Paget disease." Journal of the American Society of Cytopathology. June 6, 2026. PMID 42364948. https://doi.org/10.1016/j.jasc.2026.06.001 (Excluded: "All rights reserved" — Elsevier proprietary license. Topic: Study of 40 patients with extramammary Paget disease finding that 15% of their Pap tests showed possible cervicovaginal involvement — a finding that may be underappreciated and could have implications for how clinicians interpret Pap results in this population.)

 

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