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6 Diagnosis and referral
6.1 Summary of available scientific evidence
No directly applicable clinical studies have been identified.
6.2 Previous initiatives
Four previous1-4 initiatives presenting guidelines on diagnosis and referral were identified.
6.3 Development group comments
For accurate treatment planning sentinel lymph node SLN) procedure: yes/no; expected uni-or bilateral lymph
drainage; visibility of scar; etc. the localization of the primary tumo ur is important. Therefore excision biopsy
should be avoided.
In case of multifocal macroinvasive vulvar cancer, the patient is not eligible for SLN detection, and
inguinofemoral lymphadenectomy should be performed.
Because vulvar cancer is a rare disease and outcome of e.g. the SLN procedure is related to experience of the
treating physician, treatment should be centralized in centres with adequate experience in the treatment of this
disease.
6.4 Guidelines
In any patient suspected for vulvar cancer, diagnosis should be established by a punch/incision biopsy.
Excision biopsy should be avoided for initial diagnosis, as this may obstruct further treatment planning.
In patients with multiple vulvar lesions, all lesions should be biopsied separately with clear
documentation of mapping.
All patients with vulvar cancer should be referred to a GOC and treated by a multidisciplinary
gynaecological oncology team.
VULVAR CANCER - GUIDELINES
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