Clinical Presentation of Squamous Cell Vulvar Cancer
Squamous cell carcinoma of the vulva typically presents as a single mass or ulcer on the labia majora or minora in women over 60, most commonly accompanied by pruritus, though many cases may be asymptomatic. 1
Primary Presenting Symptoms
The clinical presentation varies based on HPV status and patient age:
HPV-Negative Tumors (Typical in Older Women)
- Single mass or ulcer on the labia majora or minora 1
- Pruritus (most common and long-lasting symptom) 2
- Vulvar bleeding or discharge 1
- Pain or irritation 1
- Dysuria 2
HPV-Positive Tumors (More Common in Younger Women)
- Multifocal lesions 1
- Concurrent cervical neoplasia 1
- May present with papillomatous plaques resembling anogenital warts 3
Anatomic Distribution
Most vulvar cancers are located in the labia majora, but other sites include 1:
- Labia minora
- Clitoris
- Mons pubis
- Perineum
Important Clinical Context
Age-Related Patterns
In older women (median age 65-70 years), vulvar SCC is typically associated with chronic scarring dermatoses such as lichen sclerosus rather than HPV infection 4. Approximately 60% of vulvar SCCs occur on a background of lichen sclerosus 4.
Stage at Presentation
Most patients present with early-stage (localized) disease 1, though delays in diagnosis are common due to both patient and physician factors 5.
Asymptomatic Presentation
Although many cases may be asymptomatic, symptomatic patients far outnumber those without symptoms 1. The majority of affected patients are symptomatic and present with the constellation of findings described above 6.
Critical Pitfall to Avoid
Do not dismiss chronic vulvar symptoms in elderly women as benign dermatologic conditions. Biopsy is essential if there is any suspicion of neoplastic change, particularly in patients with long-standing lichen sclerosus or atypical features 4. The chronic nature of symptoms and the appearance of lesions that resemble benign conditions (including warts in rare cases) can lead to dangerous diagnostic delays 3.