Page 17 - ESGO - Vulvar cancer - Complete report_fxd2

In patients with primary unifocal vulvar cancer <4 cm, inguinofemoral lymphadenectomy can be performed
immediately instead of SLN procedure in case when lymph node metastases are diagnosed preoperatively. CT or
PET/CT can be performed to rule out involvement of pelvic nodes and to decide whether or not to perform
pelvic nodal debulking. Presence of distant metastases should also be evaluated as their presence or absence may
influence the radicality of treatment of the primary tumour and the regional lymph nodes.
Treatment policy for melanomas and basal cell cancer for example is different. Depth of invasion is necessary to
decide whether groin treatment is indicated, both in squamous cell cancers as well as in melanomas.

8.4 Guidelines

 Preoperative work-up should at least include clear documentation of clinical exam (size of lesion,
distance to the midline/clitoris/anus/vagina/urethra and palpation of lymph nodes). Picture or clinical
drawing is advised (see below).

 Evaluation of the cervix/vagina/anus is recommended.
C Prior to sentinel lymph node biopsy, clinical examination and imaging of the groins (either by

ultrasound, PET-CT, or MRI) are required to identify potential lymph node metastases.
 Suspicious nodes (at palpation and/or imaging) should be analysed by FNA or core biopsy when this

would alter primary treatment.
 Further staging with CT thorax/abdomen and pelvis is recommended where there is a clinical suspicion

of, or proven (nodal) metastatic disease and/or advanced stage disease.
 The pathology report on preoperative biopsy should at least include histological type and depth of

invasion.

 VULVAR CANCER - GUIDELINES 
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