Concerning vulvar carcinoma, all of the following are true EXCEPT:
A. Etiology may be due to an HPV-dependent pathway of carcinogenesisEvidence supports an HPV-dependent pathway of carcinogenesis with risks factors similar to vulvar intraepithelial neoplasia (VIN) in the majority of cases. Vulvar carcinomas are squamous in 90% of cases. Spread of vulvar carcinoma is by direct local extension and via lymphatic microembolization. Hematogenous spread is uncommon. Staging and primary surgical treatment are typically preformed as a single procedure and tailored to the individual patient.