Current management of vulvar cancer

1. Vulvar cancer is surgically staged. 2. Imaging such as CT of the abdomen and pelvis should be performed for women with tumors 2 cm or larger or to detect lymph node or other metastases. 3. Staging should include evaluation of factors related to prognosis: tumor size, depth of invasion, lymph node involvement, and presence of distant metastases. 4. Inguinofemoral lymph node metastasis is the most important predictor of overall prognosis. 5. Inguinofemoral lymphadenectomy or sentinel lymph node evaluation can be omitted for lesions 2 cm or smaller and depth of invasion less than 1 mm. 6. Sentinel node biopsy seems to be a reliable means to pathologically assess inguinofemoral lymph node metastasis. 7. All tumors larger than 2 cm require pathologic inguinofemoral lymph node evaluation. 8. Radical local excision or modified radical vulvectomy is appropriate for most stage I and II lesions located on the lateral or posterior aspects of the vulva. 9. A tumor-free surgical margin of at least 1 cm decreases the risk of local recurrence. 10. Chemoradiation therapy is the preferred approach for most patients with very advanced vulvar cancer.