Introduction

The rarity of vulval cancer has meant that few, if any, robust randomized trials have been performed. Evidence is based largely on personal series and is therefore subject to selection bias. Centralisation of care should have gone some way to allow properly designed trials to be conducted and there are data that also suggest that this may result in an improved outcome.

CURRENT STANDARDS

1. • Vulval cancer should be managed in cancer centres by multidisciplinary teams.

2. • When considering standards of care in any disease situation, one of the primary areas to address is prevention: whether there is a preventative strategy that can be subjected to a quality assurance regimen.

Prevention and predisposing conditions

There is no screening strategy to either prevent invasive cancer of the vulva or to detect it at an early and asymptomatic stage. In approximately onethird of cases there will be evidence of a pre-existing human papillomavirus (HPV)-related disorder (vulval intraepithelial neoplasia, VIN) and an additional one-third may have evidence of a vulval maturation disorder (such as lichen sclerosus). The aetiology is far from clear, however, and it is likely that there is more than one putative oncogenic process (see Chapter 1).