Vulvar Squamous Cell Carcinoma: Scientific Progress and Impacts to Pathology Practice

Despite vulvar cancer’s rarity, meaningful advances have been made to improve the clinical care of affected patients—particularly with respect to vulvar squamous cell carcinoma (VSCC). These advances are reflected in changes to tumor classification, surgical strategies, early detection of precursors, and targeted therapeutic exploration. Refinements in histopathologic and molecular classification have enhanced diagnostic precision, enabling more accurate prognostication and facilitating personalized therapeutic decision-making, particularly tailored surgical strategies that can be explored through clinical trials—to improve patient outcomes while reducing patient morbidity. Increased awareness of VSCC precursors have also opened avenues for earlier intervention. This review highlights the key changes in the evolution of VSCC care, with particular emphasis on the expanding responsibilities of pathologists in tumor subtyping by human papillomavirus (HPV) and p53 status, biomarker-based prognostication, margin evaluation, recognition of precursors and alignment of precursor terminology (particularly HPV independent p53 wild-type lesions). By highlighting both progress and limitations, this review aims to inform future strategies that will further optimize patient outcomes and advance the standard of care in VSCC.