Vulvar cancer is one of the rarer gynecologic cancers. Previously, it was thought to affect only postmenopausal women, but a recent epidemiologic review reveals that younger premenopausal females are being affected at higher rates because of human papillomavirus infection. Family physicians are uniquely positioned as a common initial point of contact for many reproductive-age patients and can provide valuable patient education on the need for human papillomavirus vaccination and importance of addressing risk factors early. Early and prompt recognition of vulvar pathology is crucial because the diagnosis of vulvar cancer is estimated to be delayed by 2 years after initial presentation. For the family physician, routine visualization of the perineum, vulva, and labia should be considered standard of care during a routine gynecologic examination. Identification and management of risk factors including vulvar conditions (eg, lichen sclerosus) may require closer surveillance, detection of premalignant lesions, disease prevention, and/or earlier diagnosis. Suspicious lesions should be biopsied. Management depends on stage. In early stages, vulvectomy is considered with lymph node evaluation. In later stages, external beam radiation therapy, chemotherapy, and lymph node evaluation are performed. It is hoped that enhanced awareness of vulvar cancer will reduce delays in diagnosis, lead to earlier initiation of treatment, and improve survival. Survivorship care should be specific to the patient’s gynecologic concerns and attentive to maintaining their general health.
Case 4. VC, a 71-year-old cisgender woman, presents to your office with a bothersome itchy patch of skin on her vulva that has been there for several months. She had tried an over-the-counter topical steroid cream without relief.
Epidemiology
In 2025, there were an estimated 7,480 new cases of vulvar cancer and 1,770 deaths, leading to a rate of new vulvar cancer diagnoses of 2.6 per 100,000 women per year and a death rate of 0.6 per 100,000 women per year based on 2018-2022 cases and 2019-2023 deaths.1 This represents approximately 0.3% of all new cancer cases and cancer-related deaths.1 Vulvar cancer makes up 4% of female genital cancers with steadily increasing incidence in the United States.2 An increase in incidence can be attributed to the estimated delay in diagnosis of vulvar cancer by 2 years after initial concern.2 This type of cancer is most commonly diagnosed between ages 65 and 74, with 24% of all new cases occurring in this age group.
Historically, vulvar cancer was considered a gynecologic cancer primarily occurring in postmenopausal women. However, the percentage of new cases has been noted as follows: 0.1% in females younger than 20 years, 1.5% in those 20 to 34 years of age, 5.1% in those 35 to 44 years of age, and 10.5% in those ages 45 to 54 years. Of new cases, 20.8% were found in women 55 to 64 years of age, 25.9% in those 65 to 74 years of age, 22.7% in those 75 to 84 years of age, and 13.5% in those older than 84 years.1 The highest percentage of vulvar cancer–related deaths was noted in the 75 to 84 age group at 28.6%, with those older than 84 years following at 26.4% and those 65 to 74 years of age at 24.0%.1
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