Missed Diagnosis of Vaginal Cancer

This case involves a woman who was seen by a gynecologist for a routine women’s health visit. During the visit, a suspicious lesion was noticed on her vulva, which prompted the physician to take a biopsy sample. The biopsy report stated that the sample was a vulvar intraepithelial neoplasia (VIN) but was at a low potential for malignancy. The patient was told to apply cream to the affected area and to follow up six months later. The patient followed up several months later due to severe symptoms including itching, burning, and pain. She underwent a wide local incision biopsy that revealed an infiltrating squamous cell carcinoma. The tumor was found to be invasive of three millimeters and was determined to be infiltrating the surrounding tissue.

Question(s) For Expert Witness

What is the standard of care in diagnosis of this disease?

Expert Witness Response E-004584

Histological evaluation is a prerequisite before planning definitive therapy for changes in the epithelium of the vulva, whether pigmentation, hypertrophy, or lump or mass occurs. Many techniques can be used in the office setting to obtain adequate tissue for pathological evaluation. A dermal punch biopsy can be used as it is used elsewhere on the skin. If a lesion is small, excision may not only be diagnostic but also therapeutic. A local anesthetic is usually sufficient, and sutures are placed as needed.