Neoplastic lesions of the vulva and the vagina

1. Big picture

Neoplastic lesions of the vulva and vagina are clinically important because they often present with non-specific symptoms: itching, soreness, bleeding, discharge, dyspareunia, a lump, ulcer, or “wart-like” lesion. The exam danger is missing cancer because the lesion is mistaken for infection, eczema, trauma, or simple warts.

The safest oral-exam rule is:

Any persistent vulvar or vaginal lesion, ulcer, mass, pigmentation, bleeding area, or treatment-resistant “infection”
→ inspect carefully
→ biopsy

The most important malignant tumour is vulvar squamous cell carcinoma. Primary vaginal cancer is rare; when a cancer is found in the vagina, always consider whether it is actually spread from cervix, vulva, endometrium, ovary, bladder, rectum, or metastasis.

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