Herpes zoster occurs rarely in immunocompetent children and infrequently in immunocompetent young adults. However, its incidence increases with age, particularly after age 50. Reactivation of varicella-zoster virus (VZV) is characterized by a rash and is generally accompanied by considerable pain, dysesthesias, and skin hypersensitivity. Chronic pain that is sometimes experienced after the rash has healed is referred to as postherpetic neuralgia (PHN), the most common complication of herpes zoster. Postherpetic neuralgia is often severe and, unfortunately, refractory to most forms of treatment. The incidence of PHN also increases dramatically with increased age. More than 50% of zoster patients over 60 years old will develop PHN, which may persist for months and even years. Thus, established PHN is difficult to manage, often causing serious morbidity, depression, and high costs in terms of consumption of healthcare resources. Currently, early antiviral treatment with famciclovir has shown promise of reducing the duration of PHN.
Squamous cell carcinoma of the vulva is a rare disease, mainly seen in elderly women. Risk factors are advanced age, an immunocompromised status, longstanding vulvar dystrophy, VIN, a history of vulvar human papillomavirus infection, and a history of cervical cancer. Vulvar cancer should be considered as a skin tumor and detection is possible in an early stage. However, because of patients' and doctors' delay, one in three vulvar cancers is not treated before an advanced stage. The tumor metastasizes mainly lymphatogenic. Spread starts in the inguinal lymph nodes. In the middle of this century, standard treatment, consisting of an en bloc dissection of the vulva and inguinal lymph nodes has been developed and applied. As a result, considerably improved survival rates were achieved: up to 90% 5-year survival rates for patients without lymph node metastases. However, complication rates were high. In recent years, a more individualized approach has replaced standard treatment. Surgical treatment now depends on the localization, size and extent of the tumor, and is followed or preceded by radiotherapy in selected cases. The role of chemotherapy in advanced disease is currently being studied in several referral centers. The most important success in the treatment of vulvar cancer in recent years is the maintenance of high survival rates despite considerably less extensive surgical treatment, resulting in lower complications rates. An important challenge for the near future will be the improvement of the management of advanced disease. However, an even more difficult issue may be the prevention of such large lesions. The reduction of treatment delays requires a considerable effort in education of both health care workers and the general public.
The relationship between human papilloma virus (HPV) and cervical cancer is in the process of being defined. This potential opportunity to understand a human oncogenic virus has drawn significant attention to HPV. While cervical cancer is a potentially fatal outcome of HPV infection, genital warts are the most common manifestation of genital HPV infection. In addition to knowledge of etiology, natural history, and therapeutic options, patients and providers need to consider emotional impact to successfully manage the care of patients with this common infection. This article summarizes current knowledge of recent advances of HPV infection of the vulva.
Vulvar melanomas are seen in about 3% of all melanomas. The percentage reaches 10% of all malignant tumors of the vulva. The mean age of the patients is approximately 55 years. The first symptoms noticed by the patients are bleeding, pruritus, or a mass in the groin. Vulvar melanomas are mostly located at the labia minora. The differential diagnosis comprises different pigmented lesions, such as seborrheic keratosis, nevocellular nevus, lentigo, or hyperpigmentations of different origin. There is no typical histopathological pattern, but mostly melanomas of this site are of the mucosal-lentiginous type. As treatment modalities, most investigators propose a complete excision for melanomas thinner than 1 mm, and for thicker melanomas a wide excision. Recent investigations have shown that hemivulvectomies or vulvectomies do not show a better survival. The question of a prophylactic ipsilateral lymph node dissection is not answered yet. The survival rates depend on the tumor thickness and/or the infiltration level. The importance of an early diagnosis should be stressed in vulvar melanomas, especially through an accurate inspection of the vulva at the time of a genital examination. In addition, vulvar self examinations are an excellent possibility for early diagnosis. This allows a definite treatment and vulvar conservation.
