Vulvar Squamous Neoplasia

Abstract

Vulvar cancer affects 2.5 per 100,000 women per year and represents 0.4% of all new cancer cases in the USA. It is primarily a disease of elderly women with those between the ages of 75 and 84 most commonly affected. The majority of vulvar cancers (90%) are squamous cell carcinomas. In contrast to the cervix, where virtually all squamous neoplasia is driven by human papillomavirus (HPV) infection, two distinct pathways to invasive squamous cell carcinoma are recognized in the vulva: the HPV-dependent and the HPV-independent pathway. While exceptions occur and rare overlap exists, these two pathways differ with respect to epidemiologic, clinical, histopathologic, and molecular characteristics. Recently, a third pathway has been proposed but requires further investigation.