What Is Vulvar Cancer?
The vulva — the external female genitalia including the labia majora, labia minora, clitoris, and perineal body — is the site of origin of approximately 4% of all gynaecological cancers. While uncommon, vulvar cancer is largely curable when diagnosed at an early stage. The challenge is that symptoms are often dismissed, misattributed to skin conditions, or simply not discussed with a doctor.
Squamous cell carcinoma (SCC) accounts for 90% of vulvar cancers. There are two main pathways: HPV-related disease (more common in younger women, often preceded by vulvar intraepithelial neoplasia — VIN) and non-HPV-related disease in older women, frequently associated with lichen sclerosus.
Warning Signs of Vulvar Cancer
- Persistent itch (pruritus vulvae) — particularly if it has not responded to over-the-counter treatments
- A new lump, nodule, or raised area on any part of the vulva
- An ulcer or sore that does not heal within 4–6 weeks
- Skin colour or texture changes — white, red, or dark patches; thickening or scaling
- Burning or pain in the vulvar area
- Bleeding not related to menstruation
- Tenderness or swelling in the groin (may indicate lymph node involvement)
Any of these symptoms persisting for more than 4–6 weeks — especially in a postmenopausal woman — should be assessed with a biopsy. A clinical examination alone is insufficient: vulvar biopsy under local anaesthesia is a simple outpatient procedure that definitively characterises the lesion.
The Role of Lichen Sclerosus
Lichen sclerosus is a chronic inflammatory skin condition affecting the vulva and perianal area. It causes thinning, scarring, and architectural distortion of the vulvar tissues and is associated with an approximately 4–6% lifetime risk of developing squamous cell carcinoma. Women with lichen sclerosus should be under regular review, with a low threshold for biopsy if the appearance of any area changes.
Younger Women and HPV-Related Vulvar Disease
HPV-related vulvar intraepithelial neoplasia (VIN) affects younger women, often in their 30s and 40s. It presents as raised, warty or flat lesions, often multifocal, and carries a risk of progression to invasive carcinoma if untreated. Treatment options include surgical excision, laser ablation, or topical imiquimod. HPV vaccination reduces the incidence of HPV-related VIN.
Dr. Nishtha Tripathi Patel is a gynaecological oncologist in Ahmedabad specialising in all gynaecological cancers, including vulvar cancer. For a specialist assessment: +91 76988 00333.