Vulvar basal cell carcinoma: A retrospective study of 29 cases from Queensland

Objective: Review the clinical features, diagnosis, management and outcomes for 29 cases of Basal Cell Carcinoma (BCC) of the Vulva referred to Queensland Centre for Gynaecological Cancer (QCGC) between 1986 and 2010. Methods: Vulvar BCC cases from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: BCC of the vulva is uncommon with an incidence from the QCGC vulvar cancer registry of 3.2%. Of the 29 patients one died of their BCC and seven died of unrelated causes. The mean age at diagnosis was 69.5 years (range 40 to 91). All cases were Caucasian. Time from onset of symptoms to diagnosis averaged 22.6 months (range 0 - 120 months). Not until a biopsy was performed was the diagnosis made. The most common presenting complaints were pruritis and a lump. Initial treatment was surgical. Conclusions: The prognosis for vulvar BCC is excellent. Histological diagnosis and long term follow-up are important management issues. The status of disease at the margins of surgical specimens does not reliably equate to patient long term outcomes. Follow up should be supervised via a gynecological oncology register to reduce the risk of patient loss to follow up.

Bartholin’s Gland Carcinomas: A 20 plus-year experience from Queensland

Objective: To review the records of cases of Bartholin’s Gland Carcinoma referred to the Queensland Centre for Gynaecological Cancer (QCGC) between mid 1993 and mid 2012. Methods: Bartholin’s Gland Carcinoma case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences 11.0. Results: Of the 12 cases four died of their disease, seven are still alive and disease free and one is alive with recurrent disease. The mean age at diagnosis was 52.8 years. Time from onset of symptoms to diagnosis averaged 5.8 months. All diagnoses were confirmed histologically. Presenting symptoms included a lump and pain. The most common presenting complaint was a lump. Treatment included surgical excision, occasional biopsy followed by radiotherapy with or without chemotherapy. In some cases radiation and chemotherapy was followed by vulvectomy of various extent. Conclusions: Bartholin’s Gland Carcinoma is a rare condition with outcome dependent on duration of symptoms, including delay in diagnosis, cell-type, cellular differentiation and the International Federation of Gynecology and Obstetrics (FIGO) classification. A Bartholin’s gland mass in a woman aged 40 years or more should be considered malignant until a biopsy proves otherwise.The incidence of Bartholin’s Gland Carcinoma in Queensland is less than that reported elsewhere but a higher proportion of squamous cell carcinomas was found in this small series.

Vulvar sarcomas: A 25 plus-year experience from Queensland

Objective: To review the characteristics of cases of vulvar sarcomas (VS) referred to the Queensland Centre for Gynaecological Cancer (QCGC) between mid 1984 and mid 2012. Methods: VS case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: Of the nine cases three died of their disease, one died of ovarian cancer and five are still alive and disease free. The mean age at diagnosis was 54.8 years. Time from onset of symptoms to diagnosis averaged one month. All diagnoses were confirmed histologically. The most common presenting complaint was a lump. Treatment in all but one case involved surgical excision, one case had chemotherapy alone and two cases had surgery followed by radiotherapy. Conclusions: To talk of five year survival for patients with such a rare cancer, so many histological types with variable cell differentiation plus the unknown of when sarcomatous cells metastasize from even early FIGO staged lesions is in our opinion taking generalisation to far. A multidisciplinary approach to management achieves the best results for each individual and pooling multicentre data will improve our understanding of this rare disease and benefit future patients.

Melanoma of the vulva: A retrospective study of 46 cases from Queensland

Objective: To review the records of cases of vulvar melanoma referred to the Queensland Centre for Gynaecological Cancer (QCGC) between 1986 and 2009 recognising the high incidence of cutaneous melanoma in Queensland. Methods: Vulvar melanoma case data from QCGC were reviewed and analysed using the computer software Statistical Package for the Social Sciences (SPSS) 11.0. Results: Of the 46 cases 22 died of their disease, nine died of other diseases, ten are still alive and five lost to follow up. The mean age at diagnosis was 65.5 years for nodular melanoma and 69 years for superficial spreading melanoma. All cases were Caucasian. Time from on-set of symptoms to diagnosis averaged 3.2 months. In all 46 cases diagnosis was confirmed histologically. Presenting symptoms included lumps, itch, stinging, bleeding and pain. The most common presenting complaint was a lump. The initial treatment was surgical without a trend to a less radical approach to management. Conclusions: Vulvar melanoma prognosis remains guarded. Increased tumor size, depth of invasion, mitotic rate, groin lymph node positivity and status of disease at the margins of surgical specimens reliably equate to long term outcome. The incidence of vulvar melanoma was not increased in Queensland.