<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 76-year-old woman comes to the physician for evaluation of a 3-month history of vulvar itching and pain. She was diagnosed with lichen sclerosus 4 years ago. She has smoked 1 pack of cigarettes daily for 35 years. Physical examination shows a 2.5-cm nodular, ulcerative lesion on the vaginal introitus and left labia minora with surrounding erythema. Punch biopsy shows squamous cell carcinoma. A CT scan of the chest, abdomen, and pelvis shows enlarged lymph nodes concerning for metastatic disease. Which of the following lymph node regions is the most likely primary site of metastasis?? A: Superficial inguinal, B: Para-aortic, C: Inferior mesenteric, D: External iliac, E: Internal iliac,  <response>: This is a question about identifying the most likely site of lymph node metastasis from a vulvarvaginal squamous cell carcinoma. The key facts from the stem are:- 76 year old woman with history of lichen sclerosus - Long smoking history- Physical exam showed ulcerative lesion on vaginal introitus and labia minora- Biopsy confirmed squamous cell carcinoma- CT showed enlarged lymph nodes concerning for metastasesThe question asks to identify the most likely primary site of lymph node metastasis. For cancers of the vulvavagina, the initial lymph drainage is to the superficial inguinal lymph nodes. Therefore, of the choices provided, superficial inguinal lymph nodes would be the most likely site of initial lymph node metastasis.A: Superficial inguinal 