Tuesday 1 December 2020
Its been nearly 20 years since Queensland woman Pam was diagnosed with vulval cancer, but she still remembers the day clearly.
I went in for a pap smear, she says. The doctor said to me, That looks a bit weird, youve got a lesion down there. Im not happy with that, I want it looked at.
Pams doctor referred her to a gynaecologist. After a biopsy of what was actually two spots on her vulva revealed cancer, she was scheduled for immediate surgery.
Does This Look Like Vulvar Melanoma
I have a mole on my labia that I first noticed about 4 years ago. I have my gynecologist look at it during my yearly exams, and she has always said it looks fine. Two days ago I noticed it had developed a black spot that I dont remember seeing before. I’m concerned about the shape/border as well. I have no other symptoms like itching, bleeding, pain, etc. I have never been diagnosed with HPV or had an abnormal pap result. I know vulvar melanoma is rare, but the mole definitely looks suspicious to me. Does anyone know if this is what vulvar melanoma looks like? Is there something else it could be?
I do have an appointment with my PCP next week to see if he thinks I should go to a dermatologist, but in the meantime I cant stop thinking about it! Everything I have researched says the prognosis for vulvar cancer is poor, and Im only 26 years old.
Please, please offer any thoughts you have on this!!
0 likes, 8 replies
How Is Nodular Melanoma Treated
Treatment of nodular melanoma typically involves surgically removing the melanoma and some of the healthy skin surrounding the growth. A doctor may also recommend a lymph node biopsy so they can see if any cancer cells have spread to your lymph nodes.
Melanoma that has spread to lymph nodes or internal organs requires additional treatment to destroy the cancer cells. This may include:
- Immunotherapy.Immunotherapy uses drugs to help your immune system more effectively recognize and fight off cancer cells. Checkpoint inhibitors are the most commonly used immunotherapy drugs for melanoma. These drugs work by unleashing T cells, which are immune cells that target and kill tumors.
- Targeted therapy. Targeted therapy involves the use of drugs that can target and destroy cells that have specific DNA mutations. This can cause cancerous tumors to shrink or to stop growing. Targeted therapy is often used along with other treatment, such as immunotherapy.
- Radiationtherapy.Radiation therapy uses concentrated radiation beams to kill cancer cells in specific parts of your body. It is often used after surgery to ensure that all the cancer cells have been destroyed, and to decrease the risk of melanoma returning.
- Chemotherapy.Chemotherapy isnt used as often as it once was, but it may still be the best treatment for some cases.
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When To See A Doctor
Its important to see a doctor right away for any moles or skin growths that look unusual or have concerning characteristics. Its especially important to get medical attention as soon as possible for nodular melanoma due to how quickly it can spread to other parts of your body.
See a doctor immediately if you have a skin bump, growth, mole, or lesion that:
- is larger than most regular moles or spots on your body
- used to be flat but is now elevated or thicker than it used to be
- is dome-shaped or has a firm lump
- is either a single color or a mix of colors
- has either a smooth or rough, crusted surface
- has changed in its appearance
- itches or stings
If youre not sure whether a bump or growth meets these criteria, its better to be safe and have it checked out. There is no downside to being cautious and careful when it comes to your health.
To determine whether you have melanoma, a doctor will begin by first asking for details about:
- your exposure to the sun
- any personal or family history of skin cancer
- when you first noticed the growth on your skin
- how or if it has changed in shape, color, size, or elevation
During your visit, your doctor will also carefully examine your skin with a high quality magnifying glass that allows them to get a much more detailed view of the growth on your skin. They will likely also check for enlarged lymph nodes.
The next step may involve a biopsy of the mole or growth. This is the most accurate way to diagnose nodular melanoma.
Research And Clinical Trials
There may be fewer clinical trials for rare types of cancer than for more common types.
It is hard to organise and run trials for rare cancers. Getting enough patients is critical to the success of a trial. The results won’t be strong enough to prove that one type of treatment is better than another if the trial is too small.
The International Rare Cancers Initiative aims to develop more research into new treatments for rare cancers. They are designing trials that involve several countries so that more people will be available to enter trials.
Talk to your doctor or nurse if you are interested in taking part in a trial. They may know of a trial that is running in your hospital or another specialist hospital.
Also Check: Life Expectancy Metastatic Melanoma
What Causes Nodular Melanoma
Nodular melanoma happens when melanocyte cells in your skin mutate and become cancerous. Melanocytes are the cells in your skin that make melanin. This is the pigment that gives your skin its color.
Sometimes, these cells can mutate after exposure to ultraviolet radiation. The sun is by far the most significant source of UV radiation, but it can also come from other sources, such as lasers and tanning beds.
If you get too much exposure to UV radiation, it can damage the DNA of your skin cells. This can lead to mutations in the DNA, causing the cells to grow out of control.
These mutations can lead to all types of skin cancer, including nodular melanoma. More research needs to be done to determine what causes specific types of skin cancer to form.
Exposure to UV light can cause mutations in skin cells and lead to multiple types of skin cancer. Scientists dont know exactly why DNA mutations to the melanocyte cells sometimes cause nodular melanoma and not other melanomas.
However, there are some risk factors that may increase the risk of nodular melanoma:
Are There Different Stages Of Vulvar Cancer
Yes. Once vulvar cancer is diagnosed, it is categorized by its stage, which means by how far it has spread. There are four main stages:
- Stage I: In this stage, cancer is only present onthe vulva or perineum . Stage I is divided into stages, IA and IB, based on size of tumor and spread into the tissue .
- Stage II: In this stage, the tumor has spread into the lower part of the urethra, the lower part of the vagina or the anus. Cancer has not spread to the lymph nodes.
- Stage III: In this stage, the cancer has spread to one or more nearby lymph nodes. Stage III is further divided into stages IIIA, IIIB, and IIIC based on number and size of the lymph nodes involved.
- Stage IV: In this stage, the cancer has spread into the upper part of the urethra, the upper part of the vagina, or to other parts of the body. Stage IV is divided into stages IVA and IVB based on if the spread is localized near the vulva or spread distantly
If youve been diagnosed with a certain stage of cancer, ask your healthcare provider to explain the details of the specific stage and what it means.
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What Is The Vulva
The vulva is the external portion of the female genital organs. It includes:
Labia majora: two large, fleshy lips, or folds, of skin.
Labia minora: small lips just inside the labia majora surrounding the openings to the urethra and vagina.
Vestibule: space where the vagina opens
Prepuce: a fold of skin formed by the labia minora that covers the clitoris
Clitoris: a small protrusion of nerve tissue sensitive to stimulation
Fourchette: area beneath the vaginal opening where the labia minora meet
Perineum: area between the vagina and the anus
Anus: opening at the end of the anal canal
Urethra: connecting tube to the bladder
Obesity and Cancer Risk
Did you know that up to one-third of cancer deaths in women are attributed to excess body weight? Director of Gynecologic Oncology Amanda Fader and oncology dietitian Mary-Eve Brown discuss the correlation between the two. Learn what you can do to reduce your risk.
Vulvar Cancer Risk Factors
The following factors may increase a womans risk of developing vulvar cancer:
Age: Of the women who develop vulvar cancer, over 80 percent are over 50, and half are over 70.
Infection with certain types of HPV
While each woman may experience symptoms differently, the most common symptoms are:
Changes in the color and the way the vulva looks
Bleeding or discharge not related to menstruation
Severe burning, itching or pain
An open sore that lasts for more than a month
Skin of the vulva looks white and feels rough
The symptoms of vulvar cancer may look like other conditions or medical problems. Always consult a doctor for diagnosis.
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Talking To Other People
Talking to other people who have the same thing can also help.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
L Rogers and M CuelloInternational Journal of Gynaecology and Obstetrics, 2018. Volume 143, Issue S2, Pages 4 to 13
Vulvar melanoma: relevant aspects in therapeutic management
A Bittencourt Campaner and others
The Brasilian Society of Dermatology, 2017. Volume 92, Issue 3, Pages 398 to 400
British Gynaecological Cancer Society and the Royal College of Obstetricians and Gynaecologists, May 2014
Textbook of uncommon cancers D Raghavan and others, 2017John Wiley and sons
What Follow Up Should I Expect After Vulvar Cancer Treatment
Some of the tests that were done to diagnose vulvar cancer or determine the stage may be repeated. Some tests are repeated to see how well treatment is working and determine if changes need to be made.
You may continue to be tested at various time points after treatment has ended to see if your condition has changed and to make sure that the cancer has not returned. Please be sure to keep all of your check-up appointments and regularly scheduled exams.
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Treatment Of Vulvar Cancer
All or part of the vulva is surgically removed . Nearby lymph nodes are usually also removed. But sometimes doctors can instead do a sentinel lymph node What Is a Sentinel Lymph Node? Breast cancer occurs when cells in the breast become abnormal and divide uncontrollably. Breast cancer usually starts in the glands that produce milk or the tubes that carry… read more dissection . Because basal cell carcinoma of the vulva does not tend to spread to distant sites, surgery usually involves removing only the cancer. The whole vulva is removed only if basal cell carcinoma is extensive.
To identify sentinel lymph nodes, doctors inject a blue or green dye and/or a radioactive substance into the vulva around the tumor. These substances map the pathway from the vulva to the first lymph node in the pelvis. During surgery, doctors then check for lymph nodes that look blue or green or that give off a radioactive signal . Doctors remove this lymph node and send it to a laboratory to be checked for cancer. If it is cancer-free, no other lymph nodes need to be removed . For early-stage cancers, such treatment is usually all that is needed. Doctors may remove a sentinel lymph nodes on one or both sides of the vulva, depending on the size of the tumor.
After the cancer is removed, surgery to reconstruct the vulva and other affected areas may be done. Such surgery can improve function and appearance.
If You Have Signs Of Vulvar Cancer See Your Ob
Thats worth repeating: Visit your doctor if you experience any visible skin changes in the vaginal and vulvar area, as well as any discomfort or unusual symptoms, from irritation to itching. Your gynecologist views this part of the body all day and may be able to visually identify if any symptoms are a concernor simply a normal change. While it may seem scary, this is an easy area to biopsy and not very uncomfortable, says Dr. Debernardo.
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What Are The Signs And Symptoms Of Vulvar Cancer
Vulvar cancer may not cause noticeable early symptoms.
If you have one or more of the following symptoms, see your healthcare provider for an examination.
- Changes in the vulvar skin color .
- Growths or lumps in the vulva that look like a wart or ulcer or a rash or other sore that doesnt heal.
- Itching or burning in the vulvar area that does not go away.
- Bleeding in the vulvar area not related to menstruation .
- Tenderness in the vulvar area.
- Pelvic pain while having sex or peeing.
What Tests May Be Done To Find Out If Vulvar Cancer Has Spread
If cancer is found, youll undergo other tests to find out if the cancer has spread to other areas of the vulva or your body. These tests may include:
Other internal scope exams
Additional internal scope exams may be ordered, including.
- Bladder and urethra exam: A cystoscope will be inserted into your urethra to look for anything abnormal in your urethra and bladder and to take tissue samples if something abnormal is found.
- Rectum and anus exam: A proctoscope will be inserted into your rectum to look for anything abnormal in your rectum or anus and take tissue samples if something abnormal is found.
X-rays and scans
- X-rays: X-rays help show if cancer has spread to organs and bones inside the chest, and the pelvic bones.
- Intravenous pyelogram : This test uses a contrast dye, injected into a vein, and X-rays to look for blockages in your kidneys, ureters or bladder.
- CT scan and MRI : CT and MRI scans take detailed pictures of the inside of your body. A contrast dye can be used along with a CT scan to help see organs and tissues more clearly. MRI scans use a magnet and radio waves to make its pictures.
- PET scan : This scan takes pictures of the inside of your body after radioactive sugar has been injected into a vein. The glucose collects in cancerous cells, which are easily seen in the pictures.
Lymph node biopsy
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Living With Vulvar Cancer
If surgery is part of your treatment, your body may look different afterward. Talk to your doctor about this so that you are prepared. These changes may make you feel different or less attractive. It may take time to get used to the changes. Remember, your friends and family love you. Let them support you during this time. Do not push them away.
Even with treatment, vulvar cancer may not completely go away. Or, if it does, you may live in fear of it coming back. That can cause much stress for you and your loved ones. Consider joining a support group or talking to a therapist about your feelings. Invite your family to do the same.
How Do I Perform A Vulvar Self
- Stand, squat, or sit over the top of a handheld mirror, making sure you can see your genitals clearly. If it makes things easier, you may ask your partner to assist you with this.
- Check the area where your pubic hair grows. Look for any moles, spots, lesions, bumps, or rashes.
- Next, find your clitoris. Look for any growths, bumps, or discoloration.
- Check your labia majora and feel for any bumps. Also, visually look for any moles, rashes, growths, or lesions.
- Repeat this check with your labia minora .
- Finally, look at your perineum. The perineum is the space located between the vagina and the anus. Again, look for rashes, bumps, growths, and lesions.
- Report anything suspicious or abnormal to your healthcare provider, even if it seems to be small.
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Whats The Survival Rate For Women Diagnosed With Vulvar Cancer
According to the National Cancer Institute, the relative five-year survival rate for women with vulvar cancer is 71%. Higher five-year survival rates are seen in earlier stage disease compared with late stage disease .
A note from Cleveland Clinic
The earlier a cancer is discovered and treated, the better the chance of a positive, long-term outcome. You play a large role in your own health. Become familiar with all parts of your body, even your own genital area. Knowing what you look like “down there” now can help you easily identify changes. And when you see changes, make an appointment to see your healthcare provider.
Surgical Management Of Melanomas
Over the past three decades there has been a trend towards more conservative surgical treatment of squamous cancers and malignant melanomas of the vulva.12 In the early 1970s, melanomas were treated by an en bloc radical vulvectomy, bilateral inguinal-femoral lymphadenectomy, and retroperitoneal pelvic lymphadenectomy. Shortly thereafter, pelvic node dissections were performed only if Cloquet’s node was positive, or if there was clitoral involvement. By the end of the 1970s, pelvic lymphadenectomy was abandoned for the most part. Over the next two decades, there has been a trend towards even more conservative treatment. Multiple studies have now questioned the role of radical vulvectomy in many of the vulvar melanomas.