Superficially Invasive Vulvar Squamous Cell Carcinoma: A 37-Year-Long Experience of a Tertiary Referral Center

Abstract

Superficially, invasive vulvar squamous cell carcinoma (SISCCA) (FIGO stage IA) is a rare subset of vulvar cancer defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm. This is a retrospective study performed on 48 patients with SISCCA, surgically treated between 1981 and 2018 at the S. Anna Hospital, University of Turin, to evaluate pathological characteristics and prognosis of these tumors. Ten patients (21%) recurred: seven (14%) as SISCCA and three (7%) as deeply invasive carcinoma. One case with perineural invasion and groin node metastasis at recurrence. No patient had groin lymph node metastases at initial diagnosis. Site of SISCCA, type of surgery, status of surgical margins, and histopathological features did not differ between recurrent and non-recurrent patients. We observed a non-significant trend towards an increase of recurrences in younger women (median age: 63 years vs. 70 years, p = 0.09), while, surprisingly, smaller tumors (<12 mm) were significantly related to tumor relapse (p = 0.03). Overall, SISCCA has a good long-term prognosis, regardless of the pathological characteristics and the type of surgical treatment. We recommend close follow-up, especially for younger patients and for small tumors, due to the possibility of recurrence or re-occurrence even after years.

Vulvar squamous cell carcinoma arising on human papillomavirus‐independent precursors mimicking high‐grade squamous intra‐epithelial lesion: a distinct and highly recurrent subtype of vulvar cancer

“…Strikingly, most of these tumours recurred despite being at initial FIGO stage at diagnosis and with low rates of lymph node involvement, factors usually associated with improved prognosis. 27 Curiously, in a series of patients with superficially invasive VSCC, Preti et al 28 describe a higher recurrence rate in smaller tumours; the authors hypothesise that the potential presence of microscopic satellite lesions not clinically visible could be the cause of this observation. Of note, basaloid histology, which was frequent in tumours with HSIL-like adjacent lesion, has been previously associated with aggressive clinical behaviour in other cancer types, [29][30][31] especially in HPV-negative head and neck squamous cancers.…”

“…Strikingly, most of these tumours recurred despite being at initial FIGO stage at diagnosis and with low rates of lymph node involvement, factors usually associated with improved prognosis 27 . Curiously, in a series of patients with superficially invasive VSCC, Preti et al 28 . describe a higher recurrence rate in smaller tumours; the authors hypothesise that the potential presence of microscopic satellite lesions not clinically visible could be the cause of this observation.…”

Risk of Development of Vulvar Cancer in Women With Lichen Sclerosus or Lichen Planus: A Systematic Review

“…W omen have a one in 232-333 chance of developing vulvar cancer (VC) during their lifetime, and the cancer is derived from 2 pathways: vulvar high-grade squamous intraepithelial lesion (HSIL) associated with human papillomavirus (HPV) infection, and differentiated vulvar intraepithelial neoplasia (dVIN) associated with vulvar dermatosis, the latter being the cause of 75% of the cases. [1][2][3][4][5][6] Vulvar HSIL is commonly more frequent than dVIN. The latter represents less than 10% of all VIN diagnosis, 7 but the risk of progression to invasion is much higher for dVIN.…”

Effect of known pathological risk factors on the incidence of metastatic lymph nodes and survival in early‐stage vulvar cancer: SEER analysis

“…lichen sclerosis and vulvar intraepithelial neoplasia). [20][21][22] Some demonstrated that recurrence might be associated with close surgical margins and relatively large tumor size, and therefore advocated for a more aggressive surgical approach to those apparently low-risk cases. 23 In the current study, the risk of nodal metastases was approximately 8% in patients with apparent "low-" risk tumors with tumor grade 1 and tumor size ≤2 cm.…”