Clinical and Experimental Dermatology

Vulvar basal cell carcinoma treated with Mohs micrographic surgery: a case series and systematic review

Abstract Basal cell carcinoma (BCC) is the most common type of skin cancer. Vulvar BCC accounts for < 1% of all BCCs but can be difficult to manage due to its functionally and cosmetically relevant anatomical location. Mohs micrographic surgery (MMS) is a tissue-sparing technique that ensures complete margin analysis, minimizing recurrence while preserving healthy tissue. In this study, we systematically reviewed the literature, searching for cases of vulvar BCC treated with MMS. Eight articles representing 17 cases of vulvar BCC treated with MMS have been published, and we added three extra cases of our own experience. The present study highlights the relevance of including BCC in the differential diagnosis of vulvar dermatosis and the key role of MMS in the vulvar region, where tissue sparing and preservation of functionality are vital.

Pubic and vulvar papules and vesicles

We report the case of a 54-year-old woman, who had a hysterectomy and adjuvant radiation therapy for a history of cervical cancer, presenting with a 6-year history of diffuse vaginal papules and vesicles that ooze serous fluid.

Vulval hidradenoma papilliferum: a clinical and dermoscopic study

Hidradenoma papilliferum (HP) is a rare, slow-growing, benign adnexal tumour with apocrine differentiation. It usually affects the anogenital region in adult women and is clinically polymorphous, mimicking other benign or malignant neoformations. The dermoscopic features of vulval HP have not been reported yet. We report the clinical and dermoscopic features in a case series of histopathologically proven vulval HPs. Dermoscopy may be a useful tool for the diagnosis of vulval HP. To our knowledge, our paper represents the first report of dermoscopic findings in a series of vulval HPs in a multiracial population.

Thin vulvar melanoma: a challenging diagnosis. Dermoscopic features of a case series

Vulvar melanoma (VM) is rare and is often diagnosed late. Dermoscopy may aid in its recognition, differentiating VM from other more common vulvar lesions, such as melanosis and naevi. However, little is known about the dermoscopic features of thin VM. To retrospectively analyse a series of histopathologically diagnosed thin VMs and to highlight their most suggestive dermoscopic features. A multicentre, retrospective study was conducted, including histopathologically proven thin VMs, either intraepidermal or with Breslow thickness ≤ 0.5 mm, diagnosed during the period 2016-2018. We particularly focused on their dermoscopic characteristics to highlight the most suggestive dermoscopic diagnostic clues. In total, 14 cases of early-stage VM were included, in women with a mean age at diagnosis of 64.86 years. The most frequently affected sites were the labia minora. Of these, 11 cases were unifocal. Dermoscopy most often revealed structureless areas, grey globules and areas, irregular black-brown dots, blue and white structures, and red areas. In our experience, early-stage VM often exhibits dermoscopic features that are more typical of thicker cutaneous melanomas. Dermoscopy may provide useful clues for the prompt diagnosis of thin VM.

Vulval squamous cell carcinoma: a review

Abstract Vulval squamous cell carcinoma (VSCC) represents approximately 90% of all vulval cancers. Despite its rarity relative to other gynaecological or skin malignancies, the recent growing body of epidemiological and clinical evidence has resulted in important refinements to national guidelines. This review offers a comprehensive overview of the current evidence regarding the epidemiology, clinical features, diagnosis, and management of VSCC. There are two distinct aetiological pathways currently identified in the pathogenesis of VSCC. Human papillomavirus (HPV)-dependent VSCC is commonly found in younger people, driven by a persistent infection of high-risk HPV genotypes (most commonly HPV16). HPV-independent VSCC arises in association with chronic inflammatory dermatoses (typically lichen sclerosus) owing to mounting DNA damage by oxidative stress and lipid peroxidation. Globally, the incidence of vulval cancer has been rising. In 2020, the Global Cancer Observatory reported the highest incidence rates in Western Europe, Northern America and Northern Europe. Although VSCC commonly presents with a ‘suspicious vulval lesion’, early symptoms may be wide-ranging and nonspecific, leading to diagnostic delays. This is further compounded by the stigma and embarrassment felt when discussing vulval symptoms. Diagnostic workup involves a clinical history and examination, vulvoscopy and multiple biopsies. The mainstay of treatment involves surgical excision with or without chemoradiotherapy, immunotherapy and lymph node biopsies, dependent on the Federation of Gynaecology and Obstetrics staging and progression. The prognosis is heavily dependent on stage. In England, 5-year crude net survival of early-stage VSCC (stage 1–2) is 78.2%, but it falls to 33.1% at later stages (stage 3–4). This is significantly poorer than cutaneous squamous cell carcinomas elsewhere. The advent of the HPV vaccine may be the first significant medical intervention to have an impact on VSCC incidence in decades.

National screening practices in vulval extramammary Paget disease: a multicentre UK audit

National audit on screening practices on vulval extramammary Paget disease.