title: Analyzing prior clinical events at presentation in 102 women with vulvar carcinoma. Evidence of diagnostic delays.
abstract: OBJECTIVE
  To evaluate the clinical events preceding the diagnosis of squamous cell carcinoma of the vulva.
  
  
  METHODS
  One hundred two women presenting with squamous cell carcinoma of the vulva to a gynecologic oncology unit between 1989 and 1996 were prospectively evaluated by a single investigator. History, clinical findings, previous physician contact, investigations and treatment were analyzed.
  
  
  RESULTS
  Vulvar symptoms were present for more than six months in 88% and for more than five years in 28% of women. Eighty-five percent of patients had clinical evidence of abnormal skin adjacent to the cancer. Thirty-one percent of women had three or more medical consultations for vulvar symptoms prior to the diagnosis of cancer. Twenty-five percent of women had had a previous diagnostic vulvar biopsy, and 27% gave a history of having applied topical estrogen or corticosteroid to the vulva. Patients with a history of a preceding biopsy were more likely to present with stage 1 disease.
  
  
  CONCLUSIONS
  Avoidable factors appear to be present in many women who present with vulvar cancer. A more active approach to the diagnosis and management of precursor lesions may often prevent the development of vulvar cancer.
authors.affiliation: Department of Gynaecologic Oncology, National Women's Hospital, Auckland, New Zealand.
authors.forename: R W
authors.initials: RW
authors.lastname: Jones
authors.forename: E A
authors.initials: EA
authors.lastname: Joura
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008875:Middle Aged; D014846:Vulvar Neoplasms / Q000175:diagnosis* / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D004967:Estrogens