Carcinoma of the vulva

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Dermatologic Surgery

Background:

• Review of 127 patients with vulvar carcinoma treated between 1948-1970 at two London hospitals.
• Exclusion of intraepithelial carcinoma and rodent ulcer cases; inclusion of rare types like melanoma and adenocarcinoma.
• Squamous cell carcinoma was the predominant diagnosis in the reviewed series.

Purpose of the Study:

• To evaluate treatment outcomes and survival rates for various surgical approaches to vulvar cancer.
• To assess the role of leucoplakia as a precursor to vulvar cancer.
• To determine the efficacy of radical vulvectomy with lymphadenectomy and simple vulvectomy.

Main Methods:

• Retrospective review of patient records and treatment modalities.
• Surgical interventions included radiotherapy, simple vulvectomy, vulvectomy with inguinal lymphadenectomy, and radical vulvectomy with en bloc bilateral lymphadenectomy.
• Pelvic lymphadenectomy was performed based on lymph node involvement or Cloquet's node status.

Main Results:

• Radical vulvectomy combined with bilateral lymphadenectomy yielded an absolute five-year survival rate of 66%, improving to 73% with delayed skin grafting.
• Simple vulvectomy demonstrated a surprisingly good absolute five-year survival rate of 65%.
• Leucoplakia was present in only 24% of cases, suggesting it may not be as significant a precursor as previously thought, though an association remains.

Conclusions:

• Radical vulvectomy with en bloc lymphadenectomy is an effective treatment for vulvar cancer, offering excellent survival rates.
• Simple vulvectomy is a viable and effective option for elderly or infirm patients with vulvar cancer.
• The precursor role of leucoplakia in vulvar cancer may be less critical than previously assumed.