Vulvar cancer is rare, but its symptoms cause concern and often prompt a medical visit. Common signs, such as persistent itching, the presence of a lump, changes in skin color and texture, or a non-healing sore, are not exclusive to malignancy. Many benign dermatologic conditions, infections, and other growths share these outward manifestations. Understanding the spectrum of conditions that resemble vulvar cancer is necessary to avoid misdiagnosis and ensure appropriate treatment. A medical evaluation is the only way to definitively distinguish between a benign mimic and a true cancerous growth.
Chronic Inflammatory Skin Conditions
Chronic inflammatory disorders are frequent mimics of vulvar cancer, causing long-term changes to the skin’s appearance. Lichen Sclerosus (LS) often presents as thin, white, parchment-like patches, primarily affecting the labia minora and perianal area. LS causes intense itching and can lead to scarring and tissue fusion, which may be mistaken for cancerous changes. LS is relevant because chronic inflammation may progress to a non-HPV-related pre-cancerous condition.
Another mimic is Lichen Planus (LP), which typically appears as painful, reddish-purple lesions or raw, ulcerated areas in its erosive form. Whitish patterns known as Wickham’s striae can also appear on the vulva, complicating visual assessment. Contact dermatitis causes persistent redness, swelling, and cracking that may resemble a diffuse tumor. Psoriasis appears in the moist vulvar environment as smooth, red patches, mimicking persistent inflammation.
Localized Infections and Viral Lesions
Infections caused by specific pathogens can result in localized growths or sores easily mistaken for malignant lesions. Human Papillomavirus (HPV) infection causes condyloma acuminata (genital warts), which present as soft, cauliflower-like growths. These lesions can be visually identical to verrucous carcinoma, requiring a biopsy to distinguish the benign growth from the malignant one.
Herpes Simplex Virus (HSV) causes vulvar lesions, initially presenting as small, painful blisters that rupture into shallow, tender ulcers. Chronic or atypical HSV ulcers can become hypertrophic, forming large, raised, ulcerated masses that resemble an invasive carcinoma. Persistent fungal infections, such as severe candidiasis, cause profound redness, swelling, and cracking of the vulvar skin, mimicking chronic inflammation associated with advanced cancer.
Benign Cysts and Non-Infectious Masses
Discrete, palpable lumps or masses on the vulva are often alarming, yet most of these growths are benign. Bartholin’s cysts are common masses, forming when the duct of the Bartholin gland near the vaginal opening becomes blocked. These cysts present as a distinct, usually non-tender, fluid-filled swelling. If infected, they form an abscess, becoming painful and inflamed, which requires clinical differentiation from a cancerous tumor.
Other non-infectious masses include epidermal inclusion cysts, which are small, firm nodules formed when surface skin cells become trapped beneath the skin. Lipomas (soft, fatty tumors) and fibromas (firmer, fibrous growths) also occur in the vulvar area. These growths develop from underlying connective tissues and are typically mobile and non-tender, distinguishing them from the fixed, irregular, and often ulcerated appearance of an invasive vulvar cancer.
Understanding Pre-Invasive Vulvar Changes
Vulvar Intraepithelial Neoplasia (VIN) is a pre-cancerous condition that poses a diagnostic challenge. VIN, also referred to as high-grade squamous intraepithelial lesions (HSIL), involves abnormal cell growth confined strictly to the surface layer of the vulvar skin. This condition is a direct precursor to invasive vulvar squamous cell carcinoma and requires management distinct from benign diseases.
VIN often manifests as persistent, non-healing skin changes, including patches that are red, white, pink, or pigmented, and may appear slightly raised or warty. The typical form of VIN is associated with high-risk HPV infection, occurring in younger individuals and presenting with multifocal, raised lesions. Differentiated VIN, a less common and more aggressive type, is not linked to HPV but is often found alongside chronic inflammatory conditions like Lichen Sclerosus. The distinction between VIN and invasive carcinoma is based on whether abnormal cells have invaded the deeper tissue, a determination made only through a tissue biopsy.