Vulvar Cancer Surgery

Vulvar cancer

Vulvar cancer is predominantly a disease of postmenopausal women, most commonly observed in the seventh and eighth decades of life, and with a mean age at diagnosis of 65 years.

The coexistence of vulvar intraepi¬thelial neoplasia (VIN) or invasive squamous carcinoma of the vulva with in situ or invasive epidermoid carcinoma of the cervix has been demonstrated.

Risk factors for the development of invasive vulvar cancer include a history of condyloma acuminatum, VIN, smoking, and chronic vulvar dystrophies including lichen sclerosus and squamous hyper-plasia (hyperplastic dystrophy).

Detection of HIV in very young patients with vulvar cancer raises the specter of increasing rates of vulvar as well as cervical cancer as the acquired immunodeficiency syndrome (AIDS) epidemic unfolds.

Signs And Symptoms

Histologically, squamous cell carcinoma accounts for more than 90% of cases of malignancy involving the vulva.

Common presenting symptoms include

  • chronic vulvar pruritus;
  • a mass, lump, or sore;
  • ¬†and small-volume bleeding.
  • About two-thirds of the lesions involve the labia majora, whereas lesions originating on the labia minora and the clitoris occur less commonly.

Treatment of Preinvasive Disease

Small VIN lesions are treated with local excision. More extensive VIN can be treated with carbon dioxide laser vaporization. However, careful inspection and biopsies to rule out invasive disease should be done before laser treatment. Extensive disease may require wide local excision or excision of the superficial skin of the vulva (skinning vulvectomy).

Surgical Techniques

Radical Local Excision

Radical local excision involves a wide and deep excision of the lesion with the goal of clearing the lesion by 2 cm at all margins, except for posteriorly with perineal lesions in which the distance to the anus is limited.

Radical Vulvectomy And Groin Dissection

The appropriate application of groin dissection is the single most important factor in decreasing the mortality of early vulvar cancer. The technique for groin dissection involves the removal of an ellipse of skin 1 cm below and parallel to the groin crease.

Adjuvant Therapy

May be required on case-to-case individualised basis.