Which of the following is the etiologic agent in a 70 year old woman with squamous cell cancer of the vulva ?

All of the above are associated with Vulval cancer. The etiologic agents however differ according to the Age group. Two distinct etiologic entities of squamous cell carcinoma of the vulva exist : 1.Basaloid or way types, 40% of vulvar squamous cell carcinomas, Tend to be multifocal, Generally in younger patients Related to HPV infection, Usual type VIN (uVIN) Immunosuppression cigarette smoking. 2. Keratinizing account for about 60% of cases Tend to be unifocal, Predominantly in older patients, are Not related to HPV Found in areas adjacent to lichen sclerosus Chronic inflammatory dermatoses, Differentiated type VIN (dVIN).