Unsuspected invasive squamous cell carcinoma of the vulva in young women

Although the incidence of preinvasive vulvar lesions seems to be rising in the younger population, invasive squamous cell carcinoma remains exceedingly rare. As a result, diagnostic biopsy is often delayed and ablative therapy frequently instituted without an adequate histologic diagnosis. We recently treated three women aged 25 or less who had invasive squamous cell carcinoma of the vulva. In no case was the correct diagnosis initially suspected. All three patients had T2 lesions at the time of diagnosis and were treated by radical wide excision. One patient developed a second ipsilateral vulvar cancer which has recurred in the contralateral groin; the other two patients are free of disease 8 months and 4 years after resection. An awareness of the possibility of invasive vulvar carcinoma, even in the relatively young patient, should lead to prompt and thorough histologic evaluation of any vulvar lesion. Pretreatment evaluation is particularly important when ablation of extensive lesions is planned.