Journal of the American Academy of Dermatology

Treatment response and tolerability of intralesional quadrivalent versus bivalent human papillomavirus vaccine for recalcitrant warts: A randomized controlled trial

Juvenile lichen sclerosus: A loss of innocence

Impact of disease stage, treatment timing, and demographic disparities on survival in vulvar squamous cell carcinoma: Insights from a Surveillance, Epidemiology, and End Results-based analysis

Vulvar squamous cell carcinoma (VSCC) is a rare gynecologic malignancy with understudied survival outcomes. This study leverages Surveillance, Epidemiology, and End Results data to refine prognostic understanding and inform clinical decision-making. To assess overall survival (OS) in VSCC based on disease stage, treatment sequencing, timing, and demographic factors. This retrospective Surveillance, Epidemiology, and End Results study analyzed 15,055 VSCC patients (2000-2021). OS was evaluated using Kaplan-Meier analyses, stratified by disease stage, treatment modality, and timing. Socioeconomic factors, including race, income, and geographic location, were assessed for survival disparities. Patients with regional or distant metastasis had significantly worse OS compared to those with localized disease. In regional metastasis, surgery alone was associated with the best survival, with no additional benefit observed from radiation sequencing. In distant metastasis, surgery with radiation was associated with the best outcomes, and all treatment groups showed improved OS compared to no treatment. Early treatment (<30 days) improved OS, whereas delays beyond this were associated with worse outcomes. Survival disparities were observed by geography, income, and race. Optimizing treatment sequencing, ensuring timely intervention, and addressing disparities are critical to improving VSCC outcomes. Limitations include the retrospective nature of Surveillance, Epidemiology, and End Results data and lack of information on comorbidities, HPV status, and chemotherapy use.

Vulvar lichen sclerosus and vitiligo: Overlap and clinical features

Mohs micrographic surgery for vulvar malignancies: A systematic review

Human papillomavirus–induced lesions of the anogenital tract among women with vulvar high-grade squamous intraepithelial lesions

Reply to: “Comment on ‘The human papillomavirus vaccine as a treatment for human papillomavirus–related dysplastic and neoplastic conditions: A literature review’”

Comment on “The human papillomavirus vaccine as a treatment for human papillomavirus-related dysplastic and neoplastic conditions: A literature review”

Recommended guidelines for screening for underlying malignancy in extramammary Paget's disease based on anatomic subtype

Extramammary Paget's disease (EMPD) may be associated with an underlying internal adenocarcinoma, referred to as secondary EMPD. Differences in this association by EMPD anatomic subtype and implications for screening are not fully understood. Define the rates of secondary EMPD and types of associated adenocarcinomas by EMPD anatomic subtype and propose a screening algorithm for underlying adenocarcinoma. Systematic literature review of EMPD (January 1990-November 2022). One hundred twenty-two studies met the inclusion criteria. A multidisciplinary expert panel reviewed the recommendation statements on adenocarcinoma screening. Perianal EMPD was associated with a high rate of underlying adenocarcinoma (25%, primarily colorectal) compared with penoscrotal and vulvar EMPD (6% each, primarily of genitourinary origin). Thorough screening in perianal EMPD includes a colonoscopy, urine cytology, and computed tomography of the chest, abdomen, and pelvis. Cost-conscious screening tests in low-risk penoscrotal disease include urine cytology, heme-occult test, and prostate-specific antigen test (especially if under 70 years of age). For low-risk vulvar EMPD, urine cytology and mammography are recommended. EMPD with high-risk features may warrant more sensitive organ-specific testing. Selection bias; retrospective data without systematic follow-up. Screening for underlying adenocarcinoma in EMPD should be guided by anatomic location.

Human papillomavirus and vaccination

Human papillomavirus and vaccination

The human papillomavirus vaccine as a treatment for human papillomavirus–related dysplastic and neoplastic conditions: A literature review

Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.

A systematic review of laser therapy for vulvar skin conditions

Defining and quantifying histopathologic risk factors for regional and distant metastases in a large cohort of vulvar squamous cell carcinomas

Vulvar squamous cell carcinoma (vSCC) is a rare tumor with a good prognosis when treated at a localized stage. However, once regional/distant metastasis occurs, vSCC can be rapidly fatal. Thus, it is important to identify tumor prognostic features so that high-risk cases can be prioritized for further diagnostic workup and treatment. To estimate the risk of regional/distant metastasis at presentation and sentinel lymph node status for vSCC based on histopathologic characteristics. A retrospective cohort study of 15,188 adult vSCC cases from the National Cancer Database diagnosed from 2012 to 2019. We provide specific estimates of the risk of clinically positive nodes and metastatic disease at presentation and sentinel lymph node positivity according to tumor size, moderate/poor tumor differentiation, and lymph-vascular invasion. These histopathologic factors were all significantly associated with the tested clinical outcomes in a multivariable analysis. Moderate (hazard ratio, 1.190; P < .001) and poor differentiation (hazard ratio, 1.204; P < .001) and lymph-vascular invasion (hazard ratio, 1.465; P < .001) were also associated with significantly poorer overall survival. Data on disease-specific survival not available in the data set. We demonstrate the association of the histopathologic characteristics of vSCC with clinically important outcomes. These data may provide individualized information when discussing diagnostic/treatment recommendations, particularly regarding sentinel lymph node biopsy. These data may also guide future staging and risk stratification efforts for vSCC.

Elevated body mass index, statin use, and cholecystectomy are associated with vulvar lichen sclerosus: A retrospective, case-control study

Use of overhead projector sheets for vulvar dermatoscopy

Lasers as an adjuvant for vulvar lichen sclerosus: A systematic review and meta-analysis

Melanoma in situ and invasive melanoma of the vulva: An analysis of the National Cancer Database