Examination of the<unk> is part of the gynecologic evaluation and should include a thorough inspection of the perineum, including areas around the clitoris and urethra, and palpation of the Bartholin's glands. The exam may reveal an ulceration, lump or mass in the<unk>  region. Any suspicious lesions need to be sampled, or biopsied. This can generally be done in an office setting under local anesthesia. Small lesions can be removed under local anesthesia as well. Additional evaluation may include a chest X-ray, an intravenous pyelogram, cystoscopy or proctoscopy, as well as blood counts and metabolic assessment. Types Depending on the cellular origin, different histologic<unk>  subtypes may arise in<unk>  structures. Squamous cell carcinoma A recent analysis of the Surveillance, Epidemiology and End Results (SEER) registry of the US National<unk>  Institute has shown that squamous cell carcinoma accounts for approximately 75% of all<unk> s. These lesions originate from epidermal squamous cells, the most common type of skin cell. Carcinoma-in-situ is a precursor lesion of squamous cell<unk>  that does not invade through the basement membrane. There are two types of precursor lesions: * Usual-type<unk>  intraepithelial neoplasia (uVIN), which is associated with human papillomavirus (HPV) and often affects younger women. This precursor lesion progresses to basaloid or warty squamous cell carcinoma in approximately 6%. * Differentiated<unk>  intraepithelial neoplasia (dVIN), which is associated with chronic skin conditions including lichen sclerosus and lichen planus and typically affects older women. This lesion progresses to keratinizing squamous cell carcinoma in approximately 33%. Squamous lesions tend to arise in a single site and occur most commonly in the vestibule. They grow by local extension and spread via the local lymph system. The lymphatics of the labia drain to the upper<unk> and mons pubis, then to both superficial and deep inguinal and femoral lymph nodes. The last deep femoral node is called the Cloquet's node. Spread beyond this node reaches the lymph nodes of the pelvis. The tumor may also invade nearby organs such as the vagina, urethra, and rectum and spread via their lymphatics. A verrucous carcinoma of the<unk> is a rare subtype of squamous cell<unk>  and tends to appear as a slowly growing wart. Verrucous<unk> s tend to have a good overall prognosis, as these lesions hardly ever spread to regional lymph nodes or metastasize. Basal cell carcinoma Basal cell carcinoma account for approximately 8% of all<unk> s. It typically affects women in the 7th and 8th decade of life. These tend to be slow-growing lesions on the labia majora but can occur anywhere on the<unk>  Their behavior is similar to basal cell<unk> s in other locations. They often grow locally and have low risk for deep invasion or metastasis. Treatment involves local excision, but these lesions have a tendency to recur if not completely removed. Melanoma Melanoma is the third most common type and accounts for 6% of all<unk> s. These lesions arise from melanocytes, the cells that give skin color. The median age at diagnosis is 68 years; however, an analysis of the Surveillance, Epidemiology and End Results (SEER) registry of the US National<unk>  Institute has shown that it has been diagnosed in girls as young as 10 years and women up to 107 years. The underlying biology of<unk>  melanoma differs significantly from skin melanomas and mutational analyses have shown only 8% harbor a BRAF mutation compared to 70% of skin melanomas. KIT mutations, however are significantly more common in<unk>  melanoma. This has a direct impact on the medical treatment of<unk>  melanomas: BRAF-inhibitors that are commonly used in the treatment of skin melanomas, play a minor role in<unk>  melanomas. However,<unk>  melanomas frequently express PD-L1 and checkpoint inhibitors (including CTLA-4 inhibitors and PD-1 inhibitors) are effective in the treatment of advanced-stage<unk>  melanoma. In recurrent melanoma, tyrosine kinase inhibitors may be used in those patients with a KIT mutation. Based on histology, there are different subtypes of<unk>  melanoma: superficial spreading, nodular, acral lentigous and amelanotic melanoma.<unk>  melanomas are unique in that they are staged using the AJCC<unk>  staging for melanoma instead of the FIGO staging system. Diagnosis of<unk>  melanoma is often delayed and approximately 32% of women already have regional lymph node involvement or distant metastases at the time of diagnosis. Lymph node metastases and high mitotic count are indicators of poor outcome. The overall prognosis is poor and significantly worse than in skin melanomas: The median overall survival is 53 months. Bartholin gland carcinoma The Bartholin gland is a rare malignancy and usually occurs in women in their mid-sixties. Other lesions Other forms of<unk>  include invasive Extramammary Paget's disease, adenocarcinoma (of the Bartholin glands, for example) and sarcoma. Staging Anatomical staging supplemented preclinical staging starting in 1988. FIGO's revised TNM classification system uses tumor size (T), lymph node involvement (N) and presence or absence of metastasis (M) as criteria for staging. Stages I and II describe the early stages of<unk>  that still appear to be confined to the site of origin. Stage III<unk> s include greater disease extension to neighboring tissues and inguinal lymph nodes on one side. Stage IV indicates metastatic disease to inguinal nodes on both sides or distant metastases. Differential diagnosis Other<unk> ous lesions in the differential diagnosis include Paget's disease of the<unk> and<unk>  intraepithelial neoplasia (VIN). Non-cancerous<unk>  diseases include lichen sclerosus, squamous cell hyperplasia, and<unk>  vestibulitis. A number of diseases cause infectious lesions including herpes genitalis, human papillomavirus, syphilis, chancroid, granuloma inguinale, and lymphogranuloma venereum.
Vulvar cancer
Lichen sclerosus
Genital ulcer
Hyperplasia
Amurca
Bartholin's cyst
Anal cancer
Atrophic vaginitis