Andrew Bronin, MD
Andrew Bronin, MD, associate clinical professor of dermatology, Yale School of Medicine, New Haven, Connecticut. He is an editor for Journal of the American Academy of Dermatology.
Remember back in the 1960s, at the height of the feminist movement, when we women were encouraged to look at our vulvas (external genitalia) in a hand mirror so that we could learn about our bodies? Turns out there’s a medical rationale for this, too—because such self-exams help detect genital skin cancer.
Are you surprised to learn that women can get skin cancer “down there”? I sure was. Though men also get genital skin cancer, a recent study found that women are almost three times more likely to die of the most common type of this disease. It’s not clear why women’s mortality rates are higher—it might be that women are more susceptible or that this cancer is more aggressive in women…or just that growths are easier to find on male genitalia, so men get treated earlier in the progression of the disease.
The vulva includes the clitoris, labia (vaginal lips) and opening to the vagina. There are several types of vulvar cancer. To find out how to guard against these potentially deadly cancers, I spoke to Andrew Bronin, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut, and a dermatologist in private practice in Rye Brook, New York. Here are the prevention and early detection strategies he recommended to protect yourself from…
Squamous cell vulvar cancer. This skin cancer arises in the squamous cells (the layer of cells on the surface of the skin) and accounts for nearly 90% of vulvar cancers. Risk factors include age (85% of women who contract the disease are over age 50)…chronic vulvar or vaginal inflammation…infection with HIV (the AIDS virus)…or a history of cervical cancer or lichen sclerosus (a disorder characterized by thin, itchy vulvar tissues).
Squamous cell cancer can be linked to certain strains of human papillomavirus (HPV). The HPVs are a group of more than 100 related viruses, some of which are also associated with genital warts and cervical cancer. The sexually transmitted strains of HPV usually spread during vaginal, anal or oral sex via skin-to-skin contact (rather than via bodily fluids). Though the virus sometimes clears up on its own, there is no surefire way to eradicate HPV—so prevention is important. To reduce your risk…
Vulvar malignant melanoma. This type accounts for only about 4% of vulvar skin cancers, but it is the most deadly because it spreads rapidly. Melanoma develops in the melanocytes, the skin’s pigment-producing cells. You probably know that sun exposure increases the risk for malignant melanoma—but sun is not a requirement for the development of this disease. In fact, melanoma has the potential to occur anywhere that you have pigment cells…and that’s every square inch of your skin, including your vulva. You can get malignant melanoma even where the sun never shines.
“Having moles that are atypical—in other words, funny-looking to the eye and under the microscope—anywhere on your body increases your risk for vulvar malignant melanoma. So does a personal or family history of any malignant melanoma,” Dr. Bronin said. Unfortunately, vulvar melanomas have some of the worst prognoses of all malignant melanomas, with a five-year survival rate of only 50%…precisely because they often are not caught until it is too late.
Vulvar adenocarcinoma. This type begins in the gland cells just inside the vaginal opening or in the top layer of vulvar skin. It accounts for about 8% of vulvar cancers. Though less deadly than melanoma, it has a relatively high recurrence rate. Concern: Diagnosis often is delayed because a cancerous growth may be easily mistaken for a cyst.
Catching vulvar cancer early offers the best chance for a good outcome. Potentially lifesaving strategies…
Diagnosis and treatment: When suspicious growths are found, the tissue is biopsied. If the precancerous condition vulvar intraepithelial neoplasia is diagnosed, laser therapy or surgery can keep it from turning into a squamous cell cancer. If the biopsy does reveal squamous cell cancer, treatment options include laser therapy, surgery, radiation and/or chemotherapy.
If a pigmented skin lesion is suspected of being malignant melanoma, it should be surgically removed by a dermatologist or gynecologist and examined at a pathology lab. Early recognition and removal of a malignant melanoma can be lifesaving.
For vulvar adenocarcinoma, treatment also is surgical, with the extent of the surgery depending on the extent of the disease. Again, Dr. Bronin emphasized, early detection offers the best chance for limiting the necessary surgery and enhancing the prognosis.