The vulvar skin is the specialized skin adjacent to the vaginal entrance. Vulvar cancer and vaginal cancer originate in neighboring tissues and together makeup only about 5% of all the cancers that originate in the reproductive organs. Vulvar cancer occurs for 1 of every 40,000 women in the US. Vulvar cancer may occur at any age, however it typically develops over many years and is most common in women over age 50. This is a dangerous cancer and if untreated it can be life-threatening by invading neighboring tissues. It will eventually spread through the body. The most common vulvar cancer is a squamous cancer. Vulvar cancer is more common in patients who have a history of Pap smear abnormality and prior precancerous dysplasia of the cervix. The most common underlying cause is related to the family of viruses called HPV, and that explains how the same virus might cause problems in multiple parts of the anatomy including effects on the cervix and vagina and vulva.
A woman who notices persistent vulvar irritation, a new skin lump, a persistent sore, recurrent bleeding, or even painless color changes of the skin should be examined by a doctor familiar with vulvar disease. Those symptoms may be very treatable and a benign process or may be related to a small but dangerous cancer. If cancer is found, Dr. Martin can help plan treatment and recommend proper evaluation to identify the risk for spread of cancer.
Vulvar cancers may be prevented by treatment of precancerous dysplasia. Dysplasia is confined to the skin but may progress to cancer. Treatment of the dysplasia stops the developing cancer. If you have been told about vulvar dysplasia you may have seen the abbreviation VIN which stands for Vulvar Intraepithelial Neoplasia. See our website about dysplasia and colposcopy. The precancerous spots can be found if a simple exam reveals a visible skin lesion, and less visible lesions may be found during a colposcopy exam done while evaluating an abnormal Pap smear. Dr. Martin can provide treatment if exam confirms a precancerous dysplasia.
A simple office exam will identify the majority of cancers as visible suspicious lesions. Vulvar cancer is confirmed when the biopsy shows the abnormal cells are no longer confined to the skin layer and have invaded below the skin. Laser therapy works well for dysplasia but is not adequate therapy for cancer because the cancer is located deeper and below the skin. Vulvar cancer has a predictable growth and spread. Treatment takes advantage of that predictability. Early disease is routinely curable. Excision of the initial tumor would be a critical step in therapy.
Often a laser is used to treat dysplasia on the skin. The laser creates a controlled removal of the surface layers of the skin. Laser treatment can avoid treatment of the deepest layers of skin and that avoids scarring that is possible if surgical incisions are done for surgical removal. Laser therapy does have limits and when used in certain locations is more likely to create complications. Larger lesions and certain locations are better treated with surgical removal.
When skin and deeper tissue are removed from the vulva the procedure is called a vulvectomy. Most often only a portion of the vulvar anatomy would be removed and that allows preservation of appearance and function of this area of the body. Partial vulvectomy is very successful for treating all but the more advanced disease. There are many variations of that procedure and the differences refer to the extent of the tissue removed. A partial vulvectomy or a complete vulvectomy can be done. A simple vulvectomy removes less of the underlying tissue below the skin. A radical vulvectomy removes the deep tissue under the tumor and the neighboring tissue that often contains early spread. The more extensive removal is more likely to completely surround the disease and is crucial for providing cure.
Skin repair and closure may require complex procedures to speed healing and hide scars. This can be done with procedures called skin flaps or grafts. Dr. Martin has extensive experience with those procedures.
Vulvar cancer may spread to the neighboring tissues, and successful treatment for these patients may require radiation or chemotherapy.