Impact statementThe epidemiology of vulvar cancer (VSCC) is changing. Our data reveal that the age at which women are diagnosed with VSCC is falling. High-risk (HR) human papillomavirus (HPV) infection is very common in vulvar intraepithelial neoplasia (VIN) and present in just over 50% of VSCC. HR-HPV positivity was associated with lower progression rates from VIN to VSCC and improved progression-free survival of VSCC. We have conducted a detailed population-based study to examine rates of progression of VIN to VSCC, type-specific HPV prevalence in vulvar disease and the influence of HPV status on clinical outcome in VSCC. We observed that the age at which women are diagnosed with VSCC is falling and there is a significant time gap between first diagnosis of VIN and progression to invasive disease. HR-HPV infection was detected in 87% (97/112) cases of VIN and 52% cases (32/62) of VSCC. The presence of HR-HPV in squamous intraepithelial lesion was associated with lower rates of progression to invasive cancer (hazard ratio, 0.22, p=0.001). In the adjusted analysis, HR-HPV was associated with improved progression-free survival of VSCC compared to those with HPV negative tumours (hazard ratio, 0.32, p=0.02).4

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To our knowledge, this is the largest case series described and confirms the low morbidity and mortality of this procedure. However, even within our highly select group, there have been 2 cases of central recurrent disease. We, therefore, are urging caution in the global adoption of this technique and would welcome a multicenter multinational randomized controlled trial.