invasive squamous cell carcinoma of the vulva is primarily a disease of postmenopausal women and thus is rarely associated with pregnancy . we have reported on a young woman under 40 years old with vulvar carcinoma , which occurred during the pregnancy but optimal treatment was delayed to the postpartum period . this 37-year - old woman was diagnosed with 3x3 cm vulvar lesion , 2 weeks after cesarean section , subsequent biopsy revealed squamous cell carcinoma . she had a history of an ulcer on her left labia minor at the third month of the pregnancy . this case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of pregnant young women . invasive squamous cell carcinoma of the vulva is primarily a disease of postmenopausal women and thus is rarely associated with pregnancy . while squamous cell carcinomas account for about 90% of all primary vulvar malignancies , most squamous carcinomas of the vulva occur on the labia majora and minora ( 60% ) . keratinizing types of vulvar carcinoma , which tend to be unifocal and occur predominantly in older patients , are not related to hpv , and often are found in areas adjacent to the lichen sclerosisand squamous hyperplasia . physician delay is a common problem in the diagnosis of vulvar cancer , particularly if the lesion occurs in pregnancy ; therefore , any suspicious vulvar lesion detected during pregnancy should be biopsied . diagnostic delay may occur when a low suspicion of malignancy exists in the group of younger patient , due to the confusion about symptoms following the physiologic changes of pregnancy or if further investigation or treatment is postponed until the post - natal period . management is individualized   and with the exception of pelvic surgery , most surgical techniques that are used in non - pregnant patients are also safe for pregnant patients . all patients whose tumors demonstrate more than 1 mm of stromal invasion require inguino - femoral lymphadenectomy . it is clear that it is not necessary to perform a bilateral groin dissection if the primary lesion is unilateral and the ipsilateral lymph nodes are negative . independent risk factors for recurrence include the size of the tumor , lympho - vascular space involvement , multifocality of the tumor , status of surgical margin , and the presence of a concurrent vulvar intraepithelial neoplasia . in this article we presented other cases of vulvar carcinoma in the post natal period . a 37-year old iranian woman ( gravid 8 , live 6 , death 2 ) was referred to the department of gynecologic oncology at ghaem hospital , in november 2009 . two weeks before , the patient had delivered , by cesarean section , a term infant with apgar scores of 8 and 10 at one and five minutes , respectively . she had a history of progressive itching on her left labia minor of the vulva for 17 years and she had tried different therapies for her itching . a punch biopsy was taken 2 years ago by a dermatologist and was diagnosedas vulvar squamous hyperplasia . at the third month of pregnancy a physical examination revealed a 3x 3 cm lesion overlying the upper labia minor ( figure 1 ) . after admission , she underwent a vulvar biopsy and her pathologic report showed a large cell keratinizing micro - invasive squamous cell carcinoma with an invasive depth of 3 mm ( figure 2 ) . she had a normal chest x - ray and a full sexually transmitted infection screen including hiv , syphilis serology and hemophilusducrii cultures were performed and were negative . the size of the invasive scc lesion was 33 cm with no lympho - vascularinvasion . we have reported on a young woman under 40 years old with vulvar carcinoma , which occurred during the pregnancy . she was diagnosed during pregnancy , and so optimal treatment was delayed to the postpartum period . cancer of the vulva consists of 3 to 5% of all gynecologic malignancies , although it rarely occurs in pregnancy . up to 2010 , only 26 cases have been reported as vulvar cancer during pregnancy , the latter case was reported by keskin . the most common initial symptom of vulvar cancer is pruritus , which may be of a long duration . the patient often becomes aware of a lesion on her vulva ; but despite the superficial nature of the lesion , delays in seeking medical help are common . these findings underscore the need for patient and physician education with regard to the early diagnosis of carcinoma of the vulva and the importance of having a biopsy diagnosis before treating vulvar lesions.a biopsy of the vulva is a simple procedure that can be performed in the physician 's office . in our patient ; there was a delay in diagnosis from the first trimester of pregnancy to puerperium . invasive squamous cell carcinoma of the vulva involves the labia majora in about two thirds of patients . vulvar scc in young women may occur in association with or without predisposing factors that include age , cigarette smoking and venereal diseases , while chronic dermatitis is a risk factor for vulvar cancer . keratinizing types of vulvar carcinoma tend to be unifocal , and are not related to hpv , and often are found in areas adjacent to lichen sclerosis and squamous hyperplasia . our patient had a history of chronic dermatitis for 17 years and she had a biopsy two years ago that revealed concordant squamous hyperplasia . because no series of a meaningful size has been reported , our patient received standard surgical treatment and she did not require any postoperative treatment because she did not have any risk factors for recurrence , for example no lympho - vascular invasion , unifocality of the tumor , free surgical margin , and no presence of concurrent vulvar intraepithelial neoplasia . moreover , the single most important prognostic factor is lymph node status . this patient did not have any lymph node involvement ; therefore , she did not receive any additional treatments after the surgery . a careful inspection of the vulva should be a part of every gynecologic examination in pregnancy . this case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of young women . we must consider biopsies for all suspicious vulvar lesions , even in young and pregnant women . a careful inspection of the vulva should be a part of every gynecologic examination in pregnancy . this case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of young women . we must consider biopsies for all suspicious vulvar lesions , even in young and pregnant women .
backgroundinvasive squamous cell carcinoma of the vulva is primarily a disease of postmenopausal women and thus is rarely associated with pregnancy.casewe have reported on a young woman under 40 years old with vulvar carcinoma , which occurred during the pregnancy but optimal treatment was delayed to the postpartum period . 
 this 37-year - old woman was diagnosed with 3x3 cm vulvar lesion , 2 weeks after cesarean section , subsequent biopsy revealed squamous cell carcinoma . 
 she had a history of an ulcer on her left labia minor at the third month of the pregnancy . 
 she was treated by a modified radical vulvectomy and bilateral groin lymphadenectomy . 
 she did not receive any additional treatments . 
 now after two years , she has had no recurrence of the disease.conclusionthis case emphasizes on the need to consider malignancy as a differential diagnosis in vulvar lesions of pregnant young women .