Advances in Vulvar Cancer

Dear Colleagues,

Vulvar squamous cell carcinoma (VSCC) is a rare gynecological cancer mainly affecting elderly women. Two etiological pathways are recognized, one associated with high-risk human papillomavirus (HPV) infection and a second independent of HPV, usually arising in women with inflammatory dermatoses of the vulva, frequently associated with alterations in the TP53 gene. Despite the increased exposure to HPV infection in young women, this effect will probably be mitigated by the HPV vaccination. On the contrary, increasing life expectancy in high-income countries is expected to contribute to a rising prevalence of HPV-independent VSCC in the next few years. Indeed, in high-income countries, most VSCCs develop through an HPV-independent pathway, which is more complex than the HPV-associated pathway. Recent studies have shown that HPV-independent VSCC should be divided into two distinct subtypes depending on the presence or absence of TP53 mutations. These studies suggest that it would be better to divide VSCC into three instead of two clinically distinct subtypes: HPV-associated VSC, with the best prognosis, HPV-independent/TP53-mutant VSCC, with the worst outcomes, and HPV-independent/TP53-wild-type VSCC, with an intermediate prognosis. However, all types of VSCC are currently managed similarly, with surgery as the main pillar of treatment, a therapeutic approach associated with significant morbidity. Notably, patients with advanced VSCC have limited treatment options, and recurrent disease is frequently fatal. Finally, there is a very limited amount of information available on the molecular features of VSCC and associated carcinogenic pathways. Most studies have included a small number of patients, with variable selection criteria, have applied limited gene panels, and used markedly different methods. Not surprisingly, the results of these studies are very variable.

This Special Issue aims to focus on advances in understanding of molecular characteristics of VSCC and its precursor lesions, its clinical and histopathological diagnosis, therapeutic approaches, and prognostic biomarkers. The overall objective of this Special Issue is to provide new evidence on this rare and neglected women’s cancer in order to improve patient care.

Dr. Natalia Rakislova
Dr. Jaume Ordi
Guest Editors

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• vulvar squamous cell carcinoma (VSCC)
• HPV
• p53
• molecular characteristics
• diagnosis
• therapeutic approaches
• prognostic biomarkers