Early vulval cancer: the place of conservative management

There is a trend towards conservative surgery for early vulval cancer, which is increasingly being diagnosed in younger women. In this series there were 21 patients who had lesions which had invaded to a depth of 3 mm or less. Nine patients were treated by wide local excision without any form of lymphadenectomy, and eight patients had wide local excision with ipsilateral groin dissection. In the remaining four patients, radical surgery was carried out, consisting of radical vulvectomy and bilateral lymphadenectomy. None of the 12 patients who had some form of lymphadenectomy was shown to have nodal involvement. None of the patients suffered from local recurrence or recurrence in the groin nodes. No patient died from vulval cancer, and all but one of the patients are still alive with a mean follow-up period of 54.8 months. Though there is as yet no universal agreement on the criteria for early vulval cancer, with superficial invasion there is a place for individualized treatment, when patients will benefit from less than radical surgery.