[Treatment of cancer of the vulva]

The authors suggest a therapeutic scheme for carcinomata (intra-epithelial, micro-invasive and invasive) of the vulva after reviewing the literature and in the light of their own experience. It seems to them that treatment of these cancers can be carried out in the following way: Intra-epithelial cancers: partial vulvectomy for localised lesions or when treatment should be as conservative as possible. Total vulvectomy, or better still, superficial vulvectomy in other cases. Micro-invasive carcinomata: where the invasion is less than 2 mm: only total vulvectomy. Where the invasion is more than 2 mm: total vulvectomy with bilateral superficial lymphadenectomy. This is carried out as a complete lymphadenectomy when the lymph glands are found to be affected in the operating theatre. Invasive carcinomata: we exclude metastatic cancers where the local treatment is only carried out to give some palliation to the patient and sometimes can be combined with chemotherapy when that is possible. Patients that are operable: total vulvectomy with of course bilateral lymphadenectomy. This can be extended to iliac chains when Cloquet's gland is invaded. Radiotherapy after operation is to be discussed seeing that there are important sequelae from this. Lymph gland involvement can be unilateral in cases of N- stage I unilateral patients. Pelvic exenteration is only to be considered for young women who are in good general health and who have no pelvic metastases.