Groin metastasis after extensive microinvasive vulvar cancer. A case report

An increasing incidence of vulvar intraepithelial neoplasia and microinvasive vulvar cancer is being observed in younger patients. The treatment of choice is wide local excision.

A 53-year-old woman had HPV-related disease for more than 20 years. Following several operations for cervical and vulvar intraepithelial lesions (CIN 3 and VIN 3) and genital warts, she presented with extensive, multifocal VIN 3 and microinvasion at the age of 50. Since a radical approach was not feasible, combined excision and laser therapy was performed, preceded by mapping of the abnormal areas of the vulva. Two years after surgery the patient presented with a mass in the right groin. Histopathologic examination following excision revealed a groin metastasis. Postoperative radiotherapy was performed. Three years after the last vulvar surgery and 1 year after groin excision, the patient was well and disease free.

In high-risk patients with recurrent HPV-related disease of the lower genital tract and extensive microinvasive vulvar carcinoma, removal of the groin nodes should be considered. The sentinel node approach might be appropriate in the future.