Analyzing prior clinical events at presentation in 102 women with vulvar carcinoma - Evidence of diagnostic delays

OBJECTIVE: To evaluate the clinical events preceding the diagnosis of squam ous cell carcinoma of the vulva. STUDY DESIGN: One hundred two women presenting with squamous cell carcinoma of the vulva to a gynecologic oncology unit between 1989 and 1996 were pro spectively evaluated by a single investigator. History, clinical findings, previous physician contact, investigations and treatment were analyzed. RESULTS: Vulvar symptoms were present for more than six months in 88% and f or more than five years in 28% of women. Eighty-five percent of patients ha d clinical evidence of abnormal skin adjacent to the cancer. Thirty-one per cent of women and three or more medical consultations for vulvar symptoms p rior to fire diagnosis of cancer. Twenty-five percent of women had had a pr evious diagnostic vulvar biopsy, and 27% gave a history of having applied t opical estrogen or corticosteroid to the vulva. Patients with a history of a preceding biopsy were more likely to present with stage I disease. CONCLUSION: Avoidable factors appear to be present in many women who presen t with vulvar cancer. A more active approach to the diagnosis and managemen t of precursor lesions may often prevent the development of vulvar cancer.