Current insights into the aetiology, pathobiology, and management of local disease recurrence in squamous cell carcinoma of the vulva

Yap, Jason; O’Neill, Danielle; Nagenthiran, Sangeetha; Cw, Dawson; Luesley, D. M.

doi:10.1111/1471-0528.14560

Cited by 29 publications

(40 citation statements)

References 73 publications

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“…Consistent with these findings, a study of 405 New Zealand women with vulvar HSIL showed a risk of progression to malignancy of 5% of patients who received treatment versus 15% for those patients who were managed expectantly 26. dVIN accounts for a minority of the total number of VIN cases but is present adjacent to the invasive component in >40% of vulvar squamous cell carcinomas 27. This suggests that dVIN is associated with more rapid progression to invasive disease and/or the diagnosis is missed because of its subtle histopathological features.…”

Section: Methodsmentioning

confidence: 75%

Clinical and molecular classification of vulvar squamous pre-cancers

Cohen

Anderson

Eva

et al. 2019

International Journal of Gynecological Cancer

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Vulvar intraepithelial neoplasia (VIN) is a precursor to vulvar squamous cell carcinoma and is defined histopathologically by the presence of atypia. VIN has been classified into two types: usual vulvar intraepithelial neoplasia (uVIN), which is also referred to as a vulvar high-grade squamous intra-epithelial lesion (HSIL), and differentiated VIN (dVIN). The former is associated with chronic infection by sub-types of the human papilloma virus (HPV), whereas dVIN is HPV-independent and frequently associated with lichen sclerosus. The distinction is important because dVIN has a greater risk of, and more rapid transit to, vulvar squamous cell carcinoma. Furthermore, dVIN-associated vulvar cancers have an increased risk of recurrence and higher mortality than those arising from HSIL. Molecular characterization of vulvar squamous cell carcinoma precursors using next-generation sequencing is a relatively novel, but rapidly advancing field. This review appraises recent studies that have investigated the risks of progression to vulvar malignancy associated with HSIL and dVIN, the prognosis of HPV-dependent and HPV-independent vulvar squamous cell carcinomas, and conducted next generation sequencing mutation analyses to elucidate the genomic profiles underlying VIN. These studies suggest that HSIL and dVIN are characterized by different underlying molecular alterations that may have important implications for treatment and follow-up of women diagnosed with vulvar squamous cell cancer.

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Section: Methodsmentioning

confidence: 75%

Clinical and molecular classification of vulvar squamous pre-cancers

Cohen

Anderson

Eva

et al. 2019

International Journal of Gynecological Cancer

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“…The higher incidence of vulvar SCC among patients with LS has been suggested to relate to the molecularly altered epithelium generated as a result of chronic inflammation with abnormal cytokine and growth-factor production (7). It has been shown that melanocytic naevi on LS lesions differ from ordinary naevi: they contain abundant melanin, diffusely express HMB-45, and have a higher Ki-67 labelling index (6).…”

Section: Discussionmentioning

confidence: 99%

Association of Vulvar Melanoma with Lichen Sclerosus

Hieta

Kurki²,

Rintala³

et al. 2019

Acta Derm Venerol

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“…It is thought that surgeons should aim for tumor‐free pathological margins of 8 mm or more to minimize local disease recurrence. Multiple retrospective studies have tried to assess the factors that may determine vulvar recurrence, and other clinical determinants besides inadequate excision margins have been suggested, although it is unclear which combination of factors is most significant …”

Section: Surgical Management Of Vulvar Squamous Cell Carcimomamentioning

confidence: 99%

“…As most vulvar squamous carcinomas arise in a background of atypical skin such as HSIL, lichen sclerosus, and dVIN, and as they characteristically recur locally but often at sites remote from the original tumor, it is suggested that many “recurrences” may actually be second primary tumors, which arise in a “field of cancerization”—an area of genetically‐altered preneoplastic epithelium that has the predisposition to undergo malignant transformation …”

Section: Surgical Management Of Vulvar Squamous Cell Carcimomamentioning

confidence: 99%

Cancer of the vulva

Rogers

Cuello

2018

Intl J Gynecology & Obste

131

125

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Vulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized, and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors.

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Current insights into the aetiology, pathobiology, and management of local disease recurrence in squamous cell carcinoma of the vulva

Abstract: A review that discusses the key prognostic factors that influence local recurrence in vulval cancer.

Cited by 29 publications

References 73 publications

Clinical and molecular classification of vulvar squamous pre-cancers

Clinical and molecular classification of vulvar squamous pre-cancers

Association of Vulvar Melanoma with Lichen Sclerosus

Cancer of the vulva

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