Page 6 - Vulvar Cancer Guidelines Summary fxd
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SURGICAL MANAGEMENT
Local treatment
C Radical local excision is recommended.
✓ Consider additional, more superficial resection of differentiated vulvar intraepithelial neoplasia
(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 consid-
ered. 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 narrower 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 the treatment of choice.
✓ Advanced stage patients should be evaluated in a multidisciplinary setting to determine the
optimal choice and order of treatment modalities.
Local treatment
C Groin treatment should be performed for tumours > pT1a.
B For unifocal tumours < 4 cm without suspicious groin nodes on clinical examination and imag-
ing (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.
✓ Advanced stage patients should be evaluated in a multidisciplinary setting to determine the
optimal choice and order of treatment modalities.
✓ Where enlarged (> 2 cm) pelvic nodes are identified, their removal should be considered.
4 • VULVAR CANCER - GUIDELINES •
