Abstract
Simple SummarySuperficially invasive vulvar squamous cell carcinoma (SISCCA) is a rare subgroup of vulvar squamous cell carcinoma with good prognosis and low risk of groin metastasis, however experience reported in the literature is limited. The aim of our retrospective study is to present a large series of SISCCAs and analyze prognostic outcomes. We also described a case of SISCCA from our series with vulvar recurrence and groin metastasis, together with a literature review of this issue. Overall, SISCCA have a good prognosis, irrespective of type of surgical treatment, pathological characteristics, and status of surgical margins. However, patients should enter in accurate long term follow-up, in particular for younger patients and in case of small tumors, as recurrence or re-occurrence may occur even after many years after diagnosis.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.
Highlights
Vulvar cancer is a rare malignancy, accounting for 4% of all gynecological cancers in the United States of America (USA) [1]
54 were SISCCA (5.5% of the total), but we considered a total of 48 cases because six did not meet the selection criteria
We have confirmed that vulvar SISCCA is a tumor characterized by an overall good prognosis
Summary
Vulvar cancer is a rare malignancy, accounting for 4% of all gynecological cancers in the United States of America (USA) [1]. The incidence rate is similar in Western Europe with 2.4 cases per 100,000 women [2]. Many authors [3,4,5] reported an upward trend in incidence rate in developed countries: for instance, a 20% increase from 1973 to 2000 had been observed in the USA [3]. More recently, a reduction in incidence trend has been reported in most Western countries, among older women. In Italy, the total incidence significantly decreased over time with some differences across the decades: age-period cohort analysis revealed a risk reduction in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945 [6]
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