-Therapy of vulvar carcinoma in the early stages-

In the past, and still in some centres, patients with clinical stage I and II squamous cell vulvar cancer were treated by radical vulvectomy and bilateral inguinal-femoral lymphadenectomy. Modern management of vulvar cancer during the last 20 years has developed towards more conservative procedures in the therapy of early stage disease. At the Royal Hospital for Women, Sydney, women with invasive tumours < 20 mm (T1), are treated by a radical local excision. The lesion should be unifocal and the rest of the vulva healthy. A surgical margin of at least 10 mm should be obtained. If no focus with greater than 1 mm of stromal invasion is present, lymph node dissection may be omitted. Lateral lesions with a depth of invasion > 1 mm may undergo unilateral inguinal-femoral lymphadenectomy. Midline lesions and those involving the labia minora require bilateral groin dissection. In selected cases radical local excision of the primary lesion may also be performed in T2 lesions > 20 mm but should always be combined with a bilateral inguino-femoral lymphadenectomy. Adjuvant pelvic and groin irradiation should be given if at least one large node has undergone a tumorous change of if there are multiple nodes containing micrometastases. Careful patient selection is necessary to successfully achieve high cure rates, acceptable cosmetic results and psychosexual wellbeing.