Basal Cell Carcinoma
Among the rarest of the vulvar carcinomas, basal cell carcinomas occur once for every 40 invasive squamous cell carcinomas. They are distinguished by cords and masses of palisading basal cells pushing into the underlying connective tissue, and, like basal cell carcinomas elsewhere, they do Not metastasize. A history of longstanding vulvar pruritus and delay in diagnosis are common. The lesions frequently have a slightly elevated margin at their periphery. Basal cell carcinomas are most commonly found over the anterior two thirds of the labia majora and occur most frequently in white women older than age 50 years.
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The variability in clinical appearance of the vulvar tumors suggests that biopsy confirmation should be obtained on all lesions for which there is the least doubt regarding the diagnosis. In addition to basal cell carcinomas, vulvar benign lesions can include epidermal inclusion cyst, len-tigo, Bartholin duct obstruction, carcinoma in situ, melanocytic nevi, acrochordons, mucous cysts, hemangiomas, postinflammatory hyperpigmentation, seborrheic keratoses, varicosities, hidradenomas, verrucae, unusual neurofibromas, ectopic tissue, syringomas, and abscesses.
Basal cell carcinoma of the vulva is rare and was initially believed always to be indolent, locally invasive, and nonmetastasizing. However, there are reports of metastasis to regional lymph Nodes. Metastasizing basal cell carcinoma of the vulva manifests several features that distinguish it from most of the nonmetastasizing tumors. These include vaginal bleeding at presentation; advanced clinical stage; invasion of subcutaneous fat, urethra, and vagina; tumor thickness greater than 1 cm; and a pattern of growth like that of morphea. Vulvar basal cell carcinoma behaves much like its counterpart in sites other than the vulva, locally recurring but metastasizing only on rare occasions. Simple wide excision of the tumor is curative in most cases. More aggressive surgery may be warranted for large tumors that are locally destructive and extend into the subcutaneous tissue.