Invasive Squamous Cell Carcinoma
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Invasive squamous cell carcinoma of the vulva accounts for approximately 5% of all genital malignancies and 90% of vulvar malignancies. The disease occurs primarily in the sixth and seventh decades of life, although women age 25 years or younger can have invasive squamous cell carcinoma of the vulva also. An awareness of the possibility of invasive vulvar cancer, even in relatively young patients, should lead to prompt and thorough histologic evaluation of any vulvar lesion. There is evidence that HPV types 16 and 18 are associated with development of invasive squamous cell carcinoma of the vulva. In specimens with invasive squamous cell carcinoma, HPV type 16 or 18, or both, can be found. Canadian cialis pharmacy.
Invasive carcinoma usually presents with ulceration, friability, or induration of the surrounding tissues. Although most lesions are unifocal, surrounding lesions may arise, suggesting contact as a possible mechanism of induction of malignancy of the vulva. Most invasive carcinomas of the vulva are associated with surrounding areas of intra-epithelial neoplasia and frequently are associated with vulvar dystrophy. Despite this, vulvar dystrophy is not identified as a high-risk premalignant entity, and intraepithelial neoplasia seems to have a low rate of progression into invasive carcinoma.
The most widely used system for staging invasive carcinoma of the vulva was last modified in 1994 by the International Federation of Gynecology and Obstetrics (FIGO; see the box). It is a surgical staging system based on assessment of groin node involvement. Clinical groin node palpation is subject to a large margin of error, with even the most experienced observers acknowledging a 25-40% error rate. The rate of occult metastasis in patients with no palpable nodes or suspicious palpable nodes is as high as 25%. Ultrasonography may help detect positive groin nodes. These observations do not totally undermine the validity of clinical node assessment, but they do emphasize the importance of avoiding overreliance on clinical assessment of the status of the inguinal nodes and the importance of planning appropriate therapy. The surgical staging system is based on actual histologic evaluation of the lymph nodes and actual surgical extent of disease.