Clinical Findings
The patient with vulvar cancer characteristically has had infrequent medical examinations. Approximately 10% are diabetic, and 30-50% are obese or hypertensive or demonstrate other evidence of cardiovascular disease. The incidence of complicating medical illness exceeds that expected in the age group under consideration.

Invasive squamous cell cancer is a disease mainly of the seventh and eighth decades of life, although approximately 15% of patients are age 40 years or younger. Approximately 20% of patients have a second primary cancer that was diagnosed prior to, at the time of, or subsequent to the diagnosis of vulvar cancer; 75% of these second primary cancers are in the cervix.

A. SYMPTOMS AND SIGNS

Pruritus vulvae or a vulvar mass is the presenting complaint in more than 50% of patients with vulvar cancer. Other patients complain of bleeding or vulvar pain, whereas approximately 20% of patients have no complaints, and the tumor is found incidentally during routine pelvic examination. A significant number of patients, approximately 25%, have seen a physician and received various medical treatments without benefit of a biopsy of the tumor or have undergone incomplete therapy consisting of a simple excision biopsy of an invasive tumor. The importance of performing a biopsy of any vulvar lesion cannot be overemphasized.

B. DIFFERENTIAL DIAGNOSIS

Differential diagnosis of vulvar disease and exclusion of cancer depend on an adequate biopsy. The tumor may be a diffuse white lesion, a discrete tumor, an ulcer, or diffuse papules, which may not be appreciated without thorough colposcopic examination of the skin of the vulva, perineum, and perianal area.

Benign ulcerative lesions may be the result of a sexually transmitted disease (syphilis, herpes, or granuloma inguinale), pyogenic infections, or a benign tumor, such as a granular cell myoblastoma.