Case Report Vulvar Cancer with Cutaneous and Breast Metastases Nawaraj Adhikari , 1 Adarsh Vennepureddy, 2 Sara Parylo, 2 Anupma Agarwal, 3 and Meekoo Dhar 2 1 Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA 2 Department of Haematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA 3 Department of Pathology and Laboratory Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA Correspondence should be addressed to Nawaraj Adhikari; mailnawaraj@gmail.com Received 5 June 2020; Revised 9 September 2020; Accepted 10 January 2021; Published 19 January 2021 Academic Editor: Georgios D. Kotzalidis Copyright © 2021 Nawaraj Adhikari et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Vulvar cancer accounts for about 5% of cancer of female genitalia. It may initially present as benign symptoms resulting in potential delay in diagnosis. Few cases of distant metastases to skin or breast have been reported. We present the case of a 76-year- old female with possible delay in diagnosis of her squamous cell carcinoma of vulva. After 4 months of the diagnosis, she presented with concurrent cutaneous and breast metastases. 1. Introduction ere were estimated 6120 new cases of vulvar cancer in the US in the year 2020, accounting for about 5% of cancer of female genitalia and 0.6% of all cancers in women [1]. e median age at diagnosis of vulvar cancer is 68 years [2]. Vulvar cancer may initially present with nonspecific symptoms like pruritus, pain, burning sensation, bleeding, and lumps. is may be diagnosed as inflammation of Bartholin’s gland or inflammation, atrophy, or hypertrophy of vulva which may delay the diagnosis of vulvar cancer. Vulvar cancer may also arise from preexisting, known disease, like lichen sclerosus, and identifying their evolution towards tumor may be difficult, especially in early stages. Squamous cell carcinoma (SCC) accounts for about 90% of vulvar carcinoma. SCC usually presents as localized disease (59%); however, 30% presents with spread to the regional lymph node, 6% with distant metastases, and 5% unstaged [2]. Our PubMed-based search revealed that only 3 cases of vulvar carcinoma metastasis to breast and 16 cases of metastases to skin have been documented prior to our case report. Here, we present a case of squamous cell carcinoma of vulva with po- tential delay in diagnosis, which after 4 months of diagnosis presented with concurrent metastases to breast and skin. 2. Case Description A 76-year-old female with a past medical history of coronary artery disease status postcoronary artery bypass graft, hy- pertension, and aortic stenosis status postmetallic aortic valve replacement presented to the emergency department, with intense vaginal pain and bleeding for three weeks. She had history of 30 pack-years smoking in the past. She had presented to gynaecology clinic about 9 months back with mild vaginal itching and spotting. She was initially given clotrimazole/betamethasone cream which she did not tol- erate because of burning sensation and then was given topical oestrogen ointment with partial resolution of her symptoms. A transvaginal ultrasound showed an endome- trial strip of 5 mm, but no mass was visualized. She was planned for hysteroscopy and dilatation and curettage if symptoms persist; however, there was no follow-up with the gynaecology clinic for 7 months prior to this emergency department visit. Currently, her pelvic examination revealed midline clitoral mass with erythematous foul-smelling dis- charge; however, examination was limited due to severe tenderness. Rest of the physical examination was unre- markable. Examination under anaesthesia showed 4.5 cm Hindawi Case Reports in Medicine Volume 2021, Article ID 8241815, 3 pages https://doi.org/10.1155/2021/8241815