Current management of early vulvar cancer

In recent years, vulvar cancer management has been revolutionised with a more conservative approach being recommended for the primary lesion, and a more rational approach to the management of the lymph nodes. Treatment has become individualised with consideration being given independently to the optimal approach for the primary lesion and regional lymph nodes. The primary vulvar lesion can be effectively treated by radical local excision, thereby sparing the psychosexual consequences of radical vulvectomy in most patients. Local recurrence occurs in up to 10% cases whether or not radical vulvectomy has been performed, and can usually be effectively treated by further surgery and/or radiation. By contrast, recurrence in the groin is usually fatal, so any patient with a T1 lesion and more than 1 mm stromal invasion should have at least an ipsilateral inguinal-femoral lymphadenectomy performed. Postoperative groin and pelvic radiation should be given for patients with 3 or more micrometastases in lymph nodes, one macrometastasis (> or = 10 mm diameter), or any evidence of extracapsular nodal spread. The future role of lymphatic mapping to decrease the morbidity associated with complete inguinal-femoral lymphadenectomy awaits further investigation.