Early Diagnosis of Vulvar Cancer

Surgery on vulvar malignancies has become more conservative over the past several decades. A radical vulvectomy with removal of bilateral inguinal lymph nodes en bloc, a mutilating procedure fraught with high complication rates still performed in the 1980s, has become a rarity in today’s practice. This may be partially due to the fact that tumors tend to be diagnosed at earlier stages, thanks to better patient education and improved healthcare. While a more conservative surgical approach is desirable for the patient, therapeutic efficacy should not be compromised. Because of the close proximity of important structures in the vulvar region, space is often very limited for the surgeon to achieve wide enough margins around the lesion. This chapter will specifically address the issues arising in the context of diagnosing and evaluating early stage vulvar malignancies and their precursor lesions. The current concepts of carcinogenic mechanisms of vulvar neoplasms are also reviewed.