Page 24 - ESGO - Vulvar cancer - Complete report_fxd2

9.4 Guidelines

Local treatment

C Radical local excision is recommended.
 Consider additional, more superficial resection of d-VIN in addition to radical local excision of

invasive tumours.
 In multifocal invasive disease radical excision of each lesion as a separate entity may be considered.

Vulvectomy may be required in cases with multifocal invasion arising on a background of extensive
vulvar dermatosis.
 The goal of excision is to obtain tumour-free pathological margins. Surgical excision margins of at
least 1 cm are advised. It is acceptable to consider less wide margins where the tumour lies close to
midline structures (clitoris, urethra, anus) and preservation of their function is desired.
 When invasive disease extends to the pathological excision margins of the primary tumour, reexcision
is treatment of choice.
 Advanced stage patients should be evaluated in a multidisciplinary setting to determine the optimal
choice and order of treatment modalities.
Groin treatment

C Groin treatment should be performed for tumours > pT1a.
B For unifocal tumours < 4 cm without suspicious groin nodes on clinical examination and imaging (any

modality) the sentinel lymph node procedure is recommended.
C For tumours ≥ 4 cm and/or in case of multifocal invasive disease inguinofemoral lymphadenectomy by

separate incisions is recommended. In lateral tumours (medial border > 1 cm from midline) ipsilateral
inguinofemoral lymphadenectomy is recommended. Contralateral inguinofemoral lymphadenectomy
may be performed when ipsilateral nodes show metastatic disease.
D When lymphadenectomy is indicated, superficial and deep femoral nodes should be removed.
C Preservation of the saphenous vein is recommended.
 The optimal management of the groin (full inguinofemoral lymphadenectomy or isolated removal
only) for enlarged, proven metastatic nodes remains to be defined.
 Where enlarged (> 2 cm) pelvic nodes are identified, their removal should be considered.
Reconstructive surgery
 Availability of reconstructive surgical skills as part of the multidisciplinary team is required in early as
well as advanced stage disease.

 VULVAR CANCER - GUIDELINES 
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