What are the other Names for this Condition? (Also known as/Synonyms)

• Basal-Cell Cancer of Vulva
• BCC of Vulva
• Vulvar Basal Cell Carcinoma

What is Basal Cell Carcinoma of Vulva? (Definition/Background Information)

• Basal Cell Carcinoma of Vulva (or Vulvar Basal Cell Carcinoma or Vulvar BCC) is a cancerous tumor affecting the external opening around the vagina (the vulva). Vulvar BCC is more common in older women
• This type of cancer is known to be slow-growing. However, although slow-growing, the Vulvar Basal Cell Carcinoma is a malignant tumor, and is capable of metastasizing to the lymph nodes of the groin
• The tumor generally presents as a lesion on the sun-exposed areas of the body. Some lesions have the potential to increase considerably in size and ulcerate. The cancerous tumors of Vulvar BCC could potentially infiltrate into the adjoining soft tissues and nerves
• Although the exact cause of Basal Cell Carcinoma of Vulva is unknown, some risk factors for developing the condition have been characterized. These factors include prolonged and repeated sun exposure (sunbathing), exposure to tanning beds, ionizing radiations, etc. The amount of melanin in the skin also appears to play a protective role against this form of cancer, since Caucasians are reported to bear a greater risk than Africans or Asians
• For the treatment of Vulvar Basal Cell Carcinoma, a healthcare provider might choose using a combination of chemotherapy, radiation therapy, and surgery. When the tumors are small and have not metastasized, surgical removal of the tumors is considered an effective method for treatment. It has generally been observed that larger tumors have an increased probability of recurring post-treatment
• If detected and treated early, the prognosis of BCC of Vulva is considered to be excellent. However, the outcome for metastatic tumors is dictated by many factors such as the stage of the tumor, health status of the individual, and treatment response

Who gets Basal Cell Carcinoma of Vulva? (Age and Sex Distribution)

• Basal Cell Carcinoma of Vulva is commonly observed to affect elderly or older women. However, a small percentage of Vulvar BCC patients are reported to be young women
• Although women of all races and ethnicities are affected by the condition, fair-skinned women (particularly Caucasians) are reportedly more prone to the condition when compared to those with dark skin (such as Asian and African women)

What are the Risk Factors for Basal Cell Carcinoma of Vulva? (Predisposing Factors)

The following are some risk factors that may contribute to Basal Cell Carcinoma of Vulva:

• Exposure to ultraviolet (UV) light
• Prolonged and repeated sun exposure
• Use of tanning beds, tanning parlors
• Exposure to the toxic metal arsenic
• Exposure to ionizing radiation
• Smoking
• Certain genetic syndromes, such as basal cell nevus syndrome (a rare autosomal dominant disorder)
• Being fair-skinned

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Basal Cell Carcinoma of Vulva? (Etiology)

• In most cases, the exact cause of Basal Cell Carcinoma of Vulva is not completely known. Most BCCs occur in a random fashion
• Some genetic mutations have been detected in basal cell carcinomas, and are currently being characterized

What are the Signs and Symptoms of Basal Cell Carcinoma of Vulva?

Some typical symptoms associated with Basal Cell Carcinoma of Vulva include:

• BCCs are typically observed on sun-exposed areas of the body, and vulva (external opening of the vagina) is an uncommon site for this cancer type
• A growth that looks/feels like a papule or nodule, usually 1-2 cm; some nodules may grow to a size of up to 10 cm
• The surface of the papule may be red, if intact. Else, it may appear as an ulcer, if the surface is eroded
• The lesion or tumor may grow and there may be itching sensation, ulceration, and bleeding
• The tumor may be solitary or many in number. If it is associated with basal cell nevus syndrome, multiple lesions may be observed in children
• Some BCC of Vulva may resemble a melanoma (a type of skin cancer) in appearance owing to the pigmentation

How is Basal Cell Carcinoma of Vulva Diagnosed?

A healthcare provider may require one or more of the following tests to arrive at an accurate diagnosis of Basal Cell Carcinoma of Vulva:

• Complete physical examination and medical history evaluation
• Dermoscopy to examine the skin
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine change in skin pigmentation
• Skin or tissue biopsy: A skin or tissue biopsy is performed and sent to a laboratory for a pathological examination. A pathologist puts together clinical findings, special studies on tissues (if needed) and with microscope findings, arrives at a definitive diagnosis. A biopsy also rules out other types of tumor, for an accurate diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Basal Cell Carcinoma of Vulva?

The complications of Basal Cell Carcinoma of Vulva could include:

• If the tumor becomes big, develops into a firm mass and ulcerates, secondary infection with bacteria or fungus may take place
• Pain and discomfort during sex
• Metastasis to regional lymph nodes (inguinal lymph nodes) and infiltration into surrounding structures
• Emotional stress and psychological trauma in some women
• Recurrence of the tumor after a period of time, especially with large tumors
• Side effects of chemotherapy (such as toxicity) and radiation

How is Basal Cell Carcinoma of Vulva Treated?

In general, the treatment of Basal Cell Carcinoma of Vulva depends upon a variety of factors including:

• The subtype of BCC
• The number of tumors
• The size of the tumor
• Whether the tumor has metastasized

A combination of treatment methods may be used to treat Basal Cell Carcinoma of Vulva. The type of surgery may include:

• Excision of tumor: In this procedure, the tumor and surrounding tissue are removed with clear margins. Depending upon the amount of skin removed, surgical sutures may be necessary
• Moh’s surgery: In this procedure, the tumor is removed layer by layer precisely, until clear margins are achieved. Each layer removed is examined under a microscope through a ‘frozen section’ procedure, for the presence of residual tumor

In most cases, a surgical removal of the entire tumor is the preferred treatment option. This can result in a cure.

• A combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat metastatic tumors (these types of tumors are generally rare)
• Targeted therapy medications are normally used for locally infiltrated or metastatic BCCs. This therapy destroys the tumor cells by acting against the proteins that are responsible for tumor growth
• Large tumors that have infiltrated surrounding structures could be treated with radiation therapy (the use of high-energy beams to kill cancer cells)
• Large tumors after complete skin excision may need skin grafting
• Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals

Other techniques to treat the cancer (sometimes, when surgery may not be an option) may include:

• Cryotherapy: Here the tumor tissue is destroyed through a freezing technique. Typically liquid nitrogen is used to freeze the tumor
• Topical creams, such as 5-fluorouracil cream and imiquimod cream, are two examples of creams for topical treatment. These creams may be applied for several weeks, which slowly destroys the tumor

Proper follow-up care with regular screening and check-ups are important. In the case of large lesions, close follow-up and periodic observation becomes necessary, owing to their tendency to recur.

How can Basal Cell Carcinoma of Vulva be Prevented?

Currently, there are no preventive measures against Basal Cell Carcinoma of Vulva. However, the following factors may help reduce the risk for the condition:

• Avoiding or minimizing sun exposure
• Limiting the use of tanning beds, tanning parlors
• Smoking cessation
• Treating the underlying condition that caused the tumor may help in the treatment and early cure of BCC of Vulva

Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are imperative, since this type of tumor has metastasizing potential and high possibility of recurrence. Often, several years of active vigilance is necessary.

What is the Prognosis of Basal Cell Carcinoma of Vulva? (Outcomes/Resolutions)

• With early detection and prompt treatment, the prognosis of Basal Cell Carcinoma of Vulva is excellent. However, if it metastasizes to the local lymph nodes, the prognosis is guarded or unpredictable
• In cases of metastatic BCC of Vulva, the prognosis depends upon a set of several factors that include:
  • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is typically poor
  • The surgical respectability of the tumor (meaning, if the tumor can be removed completely) 
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer prognosis compared to tumors that do not recur
  • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment
• Without treatment (or with delayed treatment), Basal-Cell Cancer of Vulva can metastasize and this may result in a poor prognosis. Nevertheless, BCC metastasis is rare and occurs in about 1 in 10,000 cases only
• Close and regular follow-up and long-term monitoring for recurrence has to be maintained

Additional and Relevant Useful Information for Basal Cell Carcinoma of Vulva:

Although dirty skin is not considered a risk factor for developing Basal Cell Carcinoma of Vulva, keeping the skin clean helps avoid infections and other complications. However, it must be noted that aggressive cleaning of the skin and use of harsh chemicals and soaps should be avoided, so as to not worsen the condition.