Recent modifications in the treatment of invasive squamous cell carcinoma of the vulva

The curative potential of therapy should not be sacrificed. However, an effort must be made to determine methods that will reduce the morbidity while at least retaining the curative potential. Modifications which potentially may reduce the morbidity of regional nodal management include deletion of the inguinal lymphadenectomy or use of superficial inguinal lymphadenectomy in selected early lesions, the use of separate groin incisions, the selected use of unilateral inguinal lymphadenectomy, and the use of primary radiation therapy to the inguinal and/or pelvic nodal areas. Modifications which potentially may reduce the morbidity of the primary tumor management include wide local excision for superficial lesions, modified radical vulvectomy for regionalized lesions, the use of skin flaps in selected cases, the development of more sophisticated plastic surgical procedures for the management of posterior lesions, and the use of combined treatment modalities in the management of locally advanced disease.