Introduction/Background
Vulvar cancer is one of the less frequent gynecological tumors, with only 4% occurrence in patients, with a mean age at diagnosis of 68 years. In Mexico, it represents 0.22% of all tumors, however, its incidence in the last few years has been rising in hand with human papillomavirus infection and smoking. The most common symptoms are pruritus, ulcers, vaginal discharge, or pain. 
Squamous cell carcinoma is the most common histology (75%), followed by melanoma, basal cell carcinoma, and adenocarcinoma. At diagnosis, 59% are in early stages, 30% involve locoregional and 6% distant metastases, with an overall 5-year survival of 72%.

Methodology
Retrospective analysis of the database of Centro Universitario Contra el Cáncer from 1999 to 2019.

Results
We identified 61 patients with diagnosis of vulvar cancer, with a median age of 68 years (27 – 95), 20% history of diabetes mellitus, 80% overweight or obesity, 10% positive smoking, 85% postmenopausal, 46% had more than 3 children, 85% status performance 0 – 1 and incidence of 4 cases / year.
In relation to the disease characteristics, the median size of the tumor was 48mm. The most common histological subtype was squamous cell carcinoma, 85% with invasive component, 78% moderately differentiated, 50% lymphovascular invasion and 8% perineural invasion present; 46% had negative nodes, 38% N1 and 16% N2.
The most frequent clinical stage at diagnosis was III and only 3 patients presented distant disease (lung, bone, and rectum). Initial treatment was surgical in 60%, with radical vulvectomy in 43%, 22% unilateral lymphadenectomy, and 13% bilateral, with positive margins in 32% of cases. 30% received radiotherapy as initial treatment (dose of 30Gy / 10 Fx - 50Gy / 25 Fx), 10% concurrent weekly cisplatin with RT 45-60Gy and 20% adjuvant RT with complete response rates 25% of cases.
Only 10% of the cohort received initial chemotherapy (carboplatin or carboplatin / paclitaxel) in unresectable disease or not suitable for concurrent treatment, with a mean of 4 cycles.
From those patients that received any treatment, 40% presented recurrence or progression disease, with disease-free survival of 10.8 months and progression-free survival of 13.5 months. 
Of the 61 patients, only 4 patients are alive disease-free and 3 patients with active disease at the time of analysis.

Conclusion
Vulvar cancer has a higher prevalence and incidence in developing countries in comparison to developed countries, with the diagnosis of the disease in more advanced stages, as observed in our study of 60% stages III-IV vs 36% reported form the USA and early stages 10% vs 59% respectively.
About treatment, 2/3 underwent initial surgical treatment, nevertheless, one of every 3 patients ended with positive margins, regardless of more radical surgery, which did not translate in better oncologic outcomes but major psychosexual sequels and related morbidities.
Vulvar cancer incidence was significative higher in postmenopausal and multiparous women. For better oncological outcomes on this rare gynecologic tumor, a multidisciplinary approach must be assessed.

Disclosures
no disclosures

VULVAR CANCER: 20 YEAR OF EXPERIENCE FROM A REFERRAL CENTER IN MEXICO.