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APGO educational topic number 51
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volver neoplasms all of our carcinoma
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accounts for 5% of all gynecologic
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malignancies and is the fourth most
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common gynecologic cancer the symptoms
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can be vague and sensitive for patients
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to talk about early recognition and
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proper evaluation of vulvar neoplasms
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can reduce morbidity and mortality the
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objectives of this video are to list
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risk factors for vulvar neoplasms
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describe the symptoms and physical exam
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findings of a patient with a volver
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neoplasm and lastly list the indication
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for vulvar biopsy here is our patient
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this paretic vulva the main age of
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diagnosis is 65 20 percent of patients
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with vulvar cancers however I diagnosed
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at an age less than 50 they are thought
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to be two independent pathways for valve
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our Christina Genesis the first is
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related to HPV infection and the second
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is related to chronic inflammatory
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processes risk factors thus include
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cigarette smoking prior history of
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cervical cancer vulva or cervical
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intraepithelial neoplasia lykan
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sclerosis and northern European ancestry
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volver itching is the most common
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presenting complaint patients might
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notice a red or white ulcerative or EXO
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Finnick lesion on the posterior
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two-thirds of either labia of Ages here
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is a photograph of an exofit ik
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ulcerative lesion
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you may remember dr. vulva vagina from
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hits such as apka video number 35 vulvar
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and vaginal diseases doctor vulva vagina
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is comfortable asking her patients about
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vulvar and vaginal symptoms remember
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that many of our patients will be
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reluctant to speak with their physician
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about symptoms down there and
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unfortunately many of our patients are
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not familiar with their female anatomy
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it is very important as a woman’s health
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care provider to feel comfortable asking
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women about their symptoms to perform an
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exam if she has symptoms and at this
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point let’s briefly review vulva anatomy
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this is our patient and lithotomy the
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vulva contains the labia majora labia
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minora Mons pubis clitoris vestibule and
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ducts of glands that opened into the
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vestibule here are the labia majora the
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labia majora are the folds of skin that
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contain hair follicles as well as
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sebaceous and sweat glands
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the labia minora are the folds of skin
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within the labia majora the labia minora
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merge anteriorly with the prepuce and
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fen ulam of the clitoris and posterior
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Lee with the labia majora and the
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perineum the labia minora have no hair
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follicles but do you have sebaceous and
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sweat glands the vestibule is the area
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between the labia minora and contain the
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urethral meatus and the opening of the
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vagina which is called the vaginal
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introitus the peri urethral glands are
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scheme’s ducts have an opening here and
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the Barth Ilan’s gland empties into the
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vestibule they’re approximately 90% of
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vulvar cancers are squamous cell
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carcinomas these generally remain
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localized for long periods of time and
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then spread in a predictable fashion to
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the regional lymph nodes melanoma is the
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most common non squamous cell carcinoma
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the vulva and account for five to ten
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percent of primary vulvar neoplasms
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melanoma is most commonly located on the
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labia minora or the clitoris it usually
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presents with a raised irritated paretic
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and pigmented lesion if diagnosed early
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when confined to the intra papillary
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Ridge survival approaches 100% if the
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melanoma has invaded into the
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subcutaneous tissue survival is
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generally approximately 20% by finland
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gland carcinoma accounts for one to two
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percent of vulvar cancers the birth lung
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glands have ducts that open into the
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vestibule at the four and eight o’clock
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position on each side of the vaginal
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orifice Barthel and gland carcinomas
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generally occur in women over age 60
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however any birth leg landmass and woman
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over age 40 should be biopsied let’s go
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back to doctor vulva vagina she is
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comfortable asking patients about vulvar
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symptoms and performs an exam of the
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vulva region when patients are
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symptomatic she knows your vulva anatomy
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and she’ll have a low threshold for
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performing a vulva biopsy indications
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for vulva biopsy include lesions that
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are clinically suspicious for malignancy
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they have asymmetry
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border irregularity color variation
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bleeding or a non-healing ulcer
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if the diagnosis cannot be made
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confidently if the lesion does not
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resolve after standard therapy and
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lastly to address patient concerns this
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concludes the aapko video on vulvar
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neoplasms we have discussed how the risk
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factors relate to both HPV infection and
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chronic inflammatory processes and
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reviewed the symptoms and physical
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anatomy findings as well as the
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importance for having a low threshold
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for vulvar biopsy