2NORMAL HISTOLOGY Keratinizing stratified squamous epithelium (epidermis) Adnexal structures may be present- pilosebaceous units, and sweat glands May be involved by dermatoses that involve skin elsewhere
20SQUAMOUS HYPERPLASIA Acanthosis usually with hyperkeratosis and variable dermal inflammation Sometimes associated with carcinoma however it is not considered a premalignant lesion unless there is atypia
30HPV related in 90% of cases May be multicentric 5% of VIN III(severe dysplasia) progress to carcinoma elderly and immunosuppressed 30% associated with vaginal or cervical carcinoma
31VULVAl CARCINOMA 3% of all genital cancers in the female VULVAl CARCINOMA 3% of all genital cancers in the female. 85% are squamous cell carcinoma 15%-basal cell carcinoma, adenocarcinoma 65% have metastasized to regional nodes(inguinal, pelvic) at time of diagnosis
34Lesions less than 2 cm - 80% five-year survival rate Larger lesions with positive nodes have less than 10% five year survival rate
35Verrucous carcinoma- well differentiated squamous cell carcinoma with features of condyloma. It has a good prognosis after wide local excision and is resistant to radiation.
36Stage 0. During this stage, the cancer is a preinvasive disease called severe dysplasia, vulvar intraepithelial neoplasia (VIN), or carcinoma in situ (CIS).
37This means that the lesion is still on the surface of the vulva and has not invaded more deeply. If detected early and treated, this stage cancer should be curable.
38stages of invasive vulvar cancer. StageI stages of invasive vulvar cancer. StageI. Cancer is only in the vulva or the space between the opening of the rectum and the vagina, (perineum), or both. The tumor is 2 cm or less in size. The lymph glands and other sites do not contain cancer.
39Stage II. Cancer is in the vulva or the perineum, or both Stage II. Cancer is in the vulva or the perineum, or both. The tumor is greater than 2 cm. The lymph nodes and other sites do not contain cancer.
40Stage III. Cancer is found in the vulva or the perineum, or both Stage III. Cancer is found in the vulva or the perineum, or both. It has spread to nearby tissues such as the lower part of the urethra, the vagina, and the anus. It also may have spread to nearby groin lymph nodes. It has not spread to distant parts of the body.
41Stage IV. Cancer has spread beyond the urethra, vagina, and anus into the lining of the bladder and the intestine. It may have also spread to lymph nodes on both sides of the pelvis, the groin, or to other parts of the body.
42Recurrent. The cancer has come back after it has been treated Recurrent. The cancer has come back after it has been treated. It may come back in the vulva or another place in the body.
43VULVA: EXTRAMAMMARY PAGET'S DISEASE Large tumor cells lying singly or in small clusters within the epidermis and its appendages
45The tumor cells contain mucopolysaccharides which stain positively with PAS, alcian blue and mucicarmine Underlying adenocarcinoma is uncommon
46May be associated with carcinoma of breast, vulva or bladder-poor prognosis Otherwise it may persist for years without evidence of invasion The tumor can be present beyond the grossly apparent lesion resulting in recurrences
47MALIGNANT MELANOMA 5-10% of vulvar malignancies and 2% of all melanomas in women Peak incidence 6th to 7th decade Overall survival rate is 32% Histologically it may mimic paget's disease