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Stage III squamous cell carcinoma of the vulva with groin nodes metastasis in a patient with epidermolysis bullosa

their early teenage or perimenopausal years are most at risk (Schorge et al. 2000). Women older than 40 years experience, a 5to 10-fold increase in risk compared with younger women. Parity does not affect the risk. Lung metastases are found in 4–5% of patients with a complete hydatidiform mole and rarely in cases of partial hydatidiform moles. The wide use of ultrasound scan has led to early diagnosis of molar pregnancy. The majority of women present with symptoms of early-pregnancy failure, while presentation with hyperemesis, early severe eclamptic toxaemia, and hyperthyroidism is very rare. In this case, molar pregnancy was not suspected as the patient denied any sexual activity over the preceding 6 months and the diagnosis was made only on histological examination of the tissue sample obtained from within the uterine cavity. This was supported by the markedly raised serum bhCG and on reviewing the ultrasonic scan and MRI scan pictures. As chorionic villi were present, the diagnosis of choriocarcinoma was excluded. Suction evacuation of the uterus is the method of choice for evacuation of complete molar pregnancy because of the lack of fetal parts. Medical termination by either using syntocinon infusion or prostaglandin analogues, is not recommended because of the risk of immobilisation and dissemination of trophoblastic tissue through the venous system. Hysterectomy is rarely required. In our case, however, it was carried out as an emergency procedure because of severe life-threatening haemorrhage and intrauterine infection. All women with molar pregnancies should be registered with the Trophoblastic Tumour Screening and Treatment Centre and require follow up for 6–24 months, as determined by the Screening Centre. Urinary hCG levels are checked every week until eight normal levels are obtained, and then fortnightly until conclusion. HCG is a more reliable marker of biological behaviour of a mole since it reflects viable trophoblast (Bagshawe et al. 1973). Thus, hCG titres are a more accurate reflection of therapeutic efficacy than regression of the lung tumours, and remain the major factor on which the decision to discontinue therapy should be based (Band et al. 1976). The need for chemotherapy following complete molar pregnancy is around 15%.