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 squamous 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 prospectively 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 for more than five years in 28% of women. Eighty-five percent of patients had clinical evidence of abnormal skin adjacent to the cancer. Thirty-one percent of women had three or more medical consultations for vulvar symptoms prior to the diagnosis of cancer. Twenty-five percent of women had had a previous diagnostic vulvar biopsy, and 27% gave a history of having applied topical estrogen or corticosteroid to the vulva. Patients with a history of a preceding biopsy were more likely to present with stage 1 disease. CONCLUSION Avoidable factors appear to be present in many women who present with vulvar cancer. A more active approach to the diagnosis and management of precursor lesions may often prevent the development of vulvar cancer.