Local and regional recurrence of vulval cancer: management dilemmas

Vulval cancer has an incidence of 1-2/100000. Approximately one-third of patients develop recurrent disease usually within the first 2 years following primary treatment. Isolated vulval recurrences account for up to 50% of all cases and these recurrences are often amenable to curative surgery with radical wide local excision. Reconstruction and skin closure for larger surgical defects necessitate skin flaps. Radical exenterative procedures are considered when the recurrence involves the urethra, bladder, vagina and/or the anorectal canal. Chemoradiation therapy may be used pre-operatively or to palliate the disease. Disease recurrence in the groin is difficult to treat and is associated with very poor survival rates. Surgical effort to debulk large-volume groin disease is often unsuccessful and chemoradiation therapy is the cornerstone of treatment. The management of retroperitoneal and distant disease recurrence is generally based on symptom control as radiation therapy and chemotherapy have limited success. Palliative medicine should be integrated early in the management plan both in patients with incurable recurrent disease and in those undergoing potentially curative treatments.