Although common on the skin, basal cell carcinoma of the vulva represents only about 2% to 3% of vulvar carcinomas (Fig. 35) (64). These tend to be locally invasive lesions, but can rarely metastasize, particularly if associated with more aggressive histologic subtypes, including basosquamous, morpheaform, metatypical, or micro-nodular (65,66). Vulvar basal cell carcinomas usually occur on the labia majora, and are most often found in Caucasian women 70 years of age and older (66). Diagnosis is often late because of lack of symptoms. The tumor suppressor protein P16, over-expressed by HPV, has been detected immunohistochemically in some cases (Table 35) (67).
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