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Surgical management of vulvar cancer now favors less extensive procedures like radical local excision and sentinel node biopsy for early stages. This approach reduces morbidity while maintaining survival rates for vulvar squamous cell carcinoma.

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology
  • Dermatopathology

Background:

  • Vulvar cancer treatment has evolved from ultraradical surgeries to less invasive techniques.
  • The shift aims to improve psychosexual outcomes and reduce patient morbidity without compromising survival.

Purpose of the Study:

  • To review and discuss recent literature on the surgical management of vulvar squamous cell carcinoma.
  • To highlight the current trends and evidence-based practices in surgical treatment.

Main Methods:

  • Review of recent scientific literature on surgical management of vulvar cancer.
  • Analysis of prospective trials and clinical findings regarding surgical techniques and pathological assessment.

Main Results:

  • Radical local excision with sentinel node procedure is now standard for early-stage vulvar cancer, replacing radical vulvectomy and inguinofemoral lymphadenectomy.
  • Sentinel node biopsy is confirmed as safe for early disease, even post-tumor resection, requiring experienced teams and ultrastaging.
  • Midline tumors necessitate bilateral lymph node biopsy; debate continues regarding optimal pathological margins.

Conclusions:

  • Radical/wide local resection is a safe primary treatment for vulvar cancer.
  • Radical vulvectomy is reserved for suspicious or multifocal lesions.
  • Sentinel node procedure is suitable for unifocal disease (<4cm, clinically negative nodes); positive nodes or metastasis require inguinofemoral lymphadenectomy.