Page 7 - Vulvar Cancer Guidelines Summary fxd

Reconstructive surgery

✓ Availability of reconstructive surgical skills as part of the multidisciplinary team is required in
early as well as advanced stage disease.

SENTINEL LYMPH NODE PROCEDURE

B The sentinel lymph node procedure is recommended in patients with unifocal cancers of <
4 cm, without suspicious groin nodes.

B Use of radioactive tracer is mandatory; use of blue dye is optional.

C Lymphoscintigram is advised to enable the preoperative identification, location, and number of

sentinel lymph nodes.

Intraoperative evaluation and/or frozen sectioning of the sentinel lymph node can be per-

C formed in an attempt to prevent a second surgical procedure. Caution is warranted because of

an increased risk of missing micrometastases on final pathology due to the loss of tissue arising
from processing for frozen section assessment.

✓ When a sentinel lymph node is not found (method failure), inguinofemoral lymphadenectomy
should be performed.

C Where metastatic disease is identified in the sentinel lymph node (any size): inguinofemoral
lymphadenectomy in the groin with the metastatic sentinel lymph node.

✓ For tumours involving the midline: bilateral sentinel lymph node detection is mandatory. Where
only unilateral sentinel lymph node detection is achieved, an inguinofemoral lymphadenectomy
in the contralateral groin should be performed.

Pathological evaluation of sentinel lymph nodes should include serial sectioning at levels of

C at least every 200 µm. If the H&E sections are negative, immunohistochemistry should be

performed.

• VULVAR CANCER - GUIDELINES • 5