Management of squamous cell cancer of the vulva.

Objectives: To review and make recommendations regarding the management of early and advanced squamous cell cancer of the vulva. Options: Radical vulvectomy and groin dissection or more conservative surgery in early squamous cell vulvar cancer; chemotherapy and radiation followed by consideration of surgery in advanced disease. Outcomes: Risk of inguinal lymph node metastases, risk of tumour recurrence, patient morbidity, patient survival. Evidence: Follows the quality of evidence assessment of the Canadian Task Force on the Periodic Health Examination (Table 1). Recommendations: 1. Stage IA lesions ( 2 cm diameter and 1 mm stromal invasion) can be managed by radical local tumour excision without inguinofemoral node dissection. (II-2B) 2. Stage IB unilateral lesion ( 2 cm diameter, > 1 mm stromal invasion and 1 cm from the midline) is treated by radical wide local excision completed by an ipsilateral inguinofemoral node dissection; a central lesion (within 1 cm from the midline) requires bilateral inguinofemoral node dissection. (II-2B) 3. Patients with either three or more micrometastases in the groin with node size > 10 mm, with extracapsular spread, or with bilateral microscopic groin metastases should receive postoperative bilateral groin and pelvic radiation. (II-2B) 4. Advanced cancer of the vulva should be treated with primary radiation and concomitant chemotherapy, followed by consideration of surgical resection. (II-2B) J Obstet Gynaecol Can 2006;28(7):640–645