22 The most common vulval cancer is a squamous cell carcinoma (see Chapter 21). The other important cancers that can affect the vulva are basal cell carcinoma and melanoma, which will be discussed in this chapter. Basal cell carcinoma (BCC) is the commonest malignant tumour to affect humans, and accounts for over 75% of skin cancers. There is a significant association with chronic sun exposure and, hence, 90% of these tumours are found on sun‐exposed sites such as the head and neck or backs of hands. Vulval BCC is rare with approximately 300 cases reported in the literature. They are most common in Caucasians over the age of 60. Vulval basal cell carcinoma accounts for 2–4% of all vulval cancers and for less than 1% of BCCs overall. As the vulva is a sun‐protected site, sun exposure cannot be implicated as an aetiological factor. Chronic irritation, friction and human papilloma virus infection have been postulated but not proven. The histological features of vulval BCC are identical to those found elsewhere. Invasive nests of cells bud off from the basal epithelium with characteristic palisading of the nuclei at the periphery. Some may show squamous differentiation. It is possible to confuse BCC with the basaloid form of squamous vulval intraepithelial neoplasia. The BerEP4 stain may be helpful as this is generally positive in BCC. Pruritus is reported but the lesions may be an incidental finding with the patient noticing a lump. Pain can occur, especially if there is clitoral involvement. The classic features seen in BCC are a pearly papule with surface telangiectasia (Figure 22.1). The centre may eventually ulcerate, giving rise to the term ‘rodent ulcer’. On the vulva, this appearance is not always obvious and the lesion may be an erythematous papule or plaque (Figure 22.2), with or without ulceration. Vulval BCCs are frequently pigmented. They are most commonly found on the outer labia, mons and lower buttocks but have been reported on the inner labia, fourchette and clitoris. The major clinical differential diagnoses are of extramammary Paget’s, benign lesions or mucous cysts. Figure 22.1 Typical appearances of BCC – pearly papule. Figure 22.2 Vulval BCC – small nodule on outer labium majus. As at other sites, the lesions usually grow slowly and may be present for many years before diagnosis. They are rarely aggressive but isolated reports of metastases to the inguinal nodes exist.
Other Vulval Cancers
Basal Cell Carcinoma
Epidemiology
Incidence
Pathophysiology
Histological features
Symptoms
Clinical features
Basic Management
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