<prompt> In patient with Vulval ulcer. Which of the following will lead to malignancy?HSV1HSV2STDHPV  <response>: Ans. d HPVRef. Williams Gyenecology Ch 31HPV 16, 18 most comman cause of vulvar carcinoma. HPV infects the female - vulva, vagina, and cervix Male- urethra, penis, and scrotum. Both genders -Perianal, anal, and oropharyngeal area.Salient Features of Vulvar CancerMC site- labia majora and minoraMC symptom pruritus.MC type- SCC, epidermoid type same for vaginal CAMC implicated factor- HPV 16,18.Premalignant lesion of vulva VIN MC vulvar intraepithelial lesion ts ds Condyloma accuminata Lichen sclerosis Erythroplasia of querat Bowen disease type of VINMC mode of spread- lymphatic1st LN- superficial inguinal LN2nd LN- deep inguinal LN 