Management of Squamous Cell Cancer of the Vulva

ObjectivesTo review and make recommendations regarding the management of early and advanced squamous cell cancer of the vulva.OptionsRadical 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.OutcomesRisk of inguinal lymph node metastases, risk of tumour recurrence, patient morbidity, patient survival.EvidenceFollows the quality of evidence assessment of the Canadian Task Force on the Periodic Health Examination (Table 1).Recommendations1.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)