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Suspected vulval cancer — DRCOG MCQ

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HardGynaecological OncologySuspected vulval cancerDRCOG

A 68-year-old with lichen sclerosus has an 8-week indurated vulval ulcer that bleeds on contact despite restarting potent topical steroid. What is the most concerning diagnosis and next step?

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Correct answer: D — Vulval squamous-cell carcinoma, requiring urgent specialist assessment and biopsy

The best answer is “Vulval squamous-cell carcinoma, requiring urgent specialist assessment and biopsy”. A persistent indurated, bleeding ulcer on a background of lichen sclerosus is suspicious for vulval squamous-cell carcinoma and requires urgent specialist assessment with biopsy. Lichen sclerosus can fissure, but failure to heal with appropriate treatment and contact bleeding are red flags. Empirical infection or dermatitis treatment must not delay histological diagnosis.

Reference: NICE NG12: Suspected cancer recognition and referral: https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer