Vulvar Cancers and Precancerous Lesions - Surgical Management with Reconstructive Strategies: A Case Series of 4 Patients

Abstract

Vulvar cancer constitutes 5% of the malignancies of the female genital tract and 95% of the vulvar cancers are squamous cell carcinoma, followed by melanoma, sarcoma and basalioma. Pruritus is the most common and long-lasting reported symptom of vulvar cancer, followed by vulvar bleeding, discharge, dysuria, and pain. Diagnosis is confirmed by biopsy. The gold standard treatment of vulvar cancer is radical vulvectomy, with wide local excison of the lesion ensuring clearing margins along with enbloc resection of the inguinal lymph nodes. Vulvar intraepithelial neoplasia is a non-invasive squamous lesion, a precursor of vulvar squamous cell cancer. Clinically vulvar precancerous lesions may be flat, elevated, papulated or raised with the presence of ulcers or erosions. A thorough examination of the vulva, perineum, perianal, and anal regions, including the cervix and vagina, is essential to look for multicentricity. A good biopsy from the suspicious areas is confirmatory of diagnosis, and multiple punch biopsies should be performed for large, multicentric, and multi-colored lesions. Excisonal surgery is the treatment of choice for vulvar precancerous lesions of any type. we report 4 cases of vulvar lesions, 2 of which are vulvar cancer and two precancerous lesions of the vulva which we have diagnosed and treated in our center.