Surgery Treatment of all lesions involves wide local excision of the primary tumor (removing the tumor and some of the surrounding tissue). If the tumor is sufficiently large or invasion is noted in the biopsy specimen, a radical excision is undertaken.
All patients with tumors greater than 2 centimeters in size or with a depth of invasion greater than 1 millimeter will undergo selective groin node dissections. If the tumor crosses the midline plane of the vulva or is within 1 centimeter of the midline, bilateral nodal dissections should be undertaken. Furthermore, if nodal metastasis is found in the lymph nodes of one groin, the other groin should be explored.
Stage I tumors are subdivided according to depth of invasion.
Stage IA: Tumors with ‹1 millimeter invasion
Stage IB: Tumors with ›1 millimeter invasion
Tumors are less than 2 centimeters in greatest diameter
Tumor involves the vagina, anus, or unilateral nodes
Tumor involves bilateral nodes or distant sites
Most early stage tumors are cured with radical excision and do not need adjuvant radiation. The exception occurs when the margins of the resection are involved with the tumor or sufficiently close as to have a high likelihood of recurrence. In these cases, local irradiation would be offered. Re-excision could be performed in such cases as an alternative to radiation.
Positive margins. There is some evidence that Radiation Therapy may benefit patients with positive or close (‹8 mm) margins [3,23,37]. However, re-excision should be considered for positive or very close margins to avoid the toxicity associated with radiation therapy.
Positive groin nodes. Evidence shows that if more than one lymph node contains tumor or if extra-capsular spread is present within the lymph node, radiation therapy improves overall survival.
Unresectable advanced disease (Stage III and IV). Treatment for women with unresectable stage III and IV disease is individualized and greatly depends on tumor location, size, lymph node states, and the patient’s overall health.