Cancer of the vulva: a review

Localized carcinoma of the vulva in situ can be treated by wide local excision and continued close observation. Skinning vulvectomy, with or without subsequent skin grafting, is now well accepted as a treatment of Multifocal preinvasive disease. Microinvasive carcinoma of the vulva, on the other hand, is not treated with vulvectomy alone since the regional lymph nodes must be accurately assessed. The currently accepted treatment of invasive carcinoma of the vulva is radical vulvectomy and bilateral groin lymph node dissection. No longer is pelvic lymph node dissection to be considered a routine part of this therapy but is included only under specific circumstances. On rare occasion a more radical procedure such as anterior or posterior pelvic exenteration is considered appropriate therapy when the geographic location of the tumor requires this approach. The treatment of recurrent disease is influenced by its extent and location and must be tailored for the individual patient. Palliative vulvectomy is still used as a treatment of the far advanced disease in an attempt to improve personal and social hygiene, as well as to control serious infection and to prevent localized hemorrhage. The role of x-ray therapy in the treatment of carcinoma of the vulva is discussed.