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Pruritus vulvae - Management
How should I manage pruritus vulvae caused by a possible neoplasm?
- Refer urgently (within 2 weeks) all women with an unexplained vulval lump or ulcer.
- If the woman presents with vulval pruritus or pain, but no other specific features, it is reasonable to use a period of 'treat, watch, and wait' as initial management. The woman should be followed up until symptoms resolve or a diagnosis is confirmed. If symptoms persist, refer with urgency depending on the symptoms and degree of concern about cancer.
- Vulval intraepithelial neoplasia — a skin biopsy is required to confirm the diagnosis and pick up any early cancers. As 50% of women have associated abnormalities including cervical intraepithelial neoplasia or cancer, it is very important to have annual cervical smears.
- Usually all vulval intraepithelial neoplasia lesions are treated to reduce the risk of cancer (in secondary care). Treatments which may be offered include removal of affected tissue, topical imiquimod, or 5-fluorouracil.
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