The pelvic examination begins with a visual inspection of the external geni- talia using the assistance of a good light source. Although skin cancer is rare in this region, it is often diagnosed late. Vulvar cancer can be hyperpig- mented, erythematous, or hypopigmented, and any such lesions require care- ful evaluation and often biopsy (see Chapter 17). Lichen sclerosus is a relatively common condition in which the vulvar skin may appear like parch- ment. It is more common in postmenopausal women, but occurs in all ages, and can be associated with cancer. . | Special Article Gynecologic Cancers in Pregnancy Guidelines of an International Consensus Meeting Frédéric Amant MD PhD Kristel Vein Calsteren MD Michael J. Halaska MD t Jos Beijnen MD PhD ị Lieven Lagae MD PhD Myriam Hanssens MD PhD ỊI Liesheth Heyns MSc Lore Lannoo MD H Neỉleke p Ottevanger MD Ph DJI Walter Vanden Bogaert MD PhD Laszlo Ungar MD Ignace Vergote MD PhD and Andreas dll Bois MD PlỉDịị Background Gynecologic cancer during pregnancy is a special challenge because cancer or its treatment may affect not only the pregnant women in general but directly involve the reproductive tract and fetus. Currently there arc no guidelines on how to deal with this special coincidence. Methods An international consensus meeting on staging and treatment of gynecological malignancies during pregnancy was organised including a systematic literature search and interpretation followed by a physical meeting of all participants with intensive discussion. In the absence of large trials and randomized studies recommendations were based on available literature data and personal experience thus representing a low but best achievable level of evidence. Findings Randomized trials and prospective studies on cancer treatment during pregnancy arc lacking. Gynecological cancer during pregnancy is a demanding problem and multidisciplinary expertise should be available. Counseling both parents on the maternal prognosis and fetal risk is needed. When there is a firm desire to continue the pregnancy gynecological cancer can be treated in selected cases. The staging and treatment should follow the standard approach as much as possible. Guidelines for safe pelvic surgery during pregnancy arc presented. Mainly in cervical and ovarian cancer chemotherapy and an alternative surgical approach need to be considered. Administration of chemotherapy during the second or third trimester may probably not increase the incidence of congenital malformations. Until now the long-term outcome of .

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