Diagnosis and management of vulvar carcinoma

With the steady increase in life expectancy, invasive cancer of the vulva is now becoming more prominent among gynecologic malignancies. Early, careful examinations and informed patients can aid in early diagnosis. Carcinoma in situ, verified by biopsy, is best treated with wide local excision. Invasive vulvar carcinoma should be treated with radical vulvectomy and bilateral groin node dissection. The major source of morbidity is wound breakdown. The use of modified incision techniques and sartorius muscle transplantation have significantly decreased these postoperative complications. The clinical staging system for vulvar carcinoma is approved by the International Federation of Gynecology and Obstetrics (FIGO). The disease usually spreads systematically from the vulva to superficial groin nodes, to deep groin nodes, and then to pelvic nodes. Survival rates of 84% for stage I disease can be achieved. Evidence of positive groin nodes indicates a poor prognosis. However, even patients with advanced disease can be surgically cured by radical surgery. Five of ten patients (50%) with stage IV disease were alive and free of disease at five years with exenterative surgery. Any patient who is a reasonable medical risk, with a vulvar lesion that is resectable, should be treated surgically. Otherwise, the patients not only die, but they die in abject misery.