Vulvar Cancer

Biopsy any clinically concerning raised vulvar lesion before ablative or definitive surgical therapy when invasive carcinoma is possible. Visual assessment identifies the target, but histologic interpretation remains the diagnostic standard for invasive disease. ScienceDirectScienceDirectVulvar Intraepithelial Neoplasia - an overview

After carcinoma is confirmed, document lesion location, local extension, and bilateral groin examination because vulvar squamous cell carcinoma is primarily managed by resection of the primary tumor plus inguinofemoral nodal staging when appropriate. BMJ+1BMJPrimary vulvar squamous cell carcinomas with high T ...WileyComprehensive management of vulvovaginal cancers - 2025 Obtain MRI, CT, or PET when the local extent, regional nodal status, or more distant disease would alter operative planning or favor multimodality treatment. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics

Use pathology to distinguish HPV-associated biology from non-HPV-associated pathways when this information is clinically or diagnostically relevant. Diffuse, intense nuclear and cytoplasmic p16 staining correlates with high-risk HPV infection, whereas focal or weak p16 staining should not be interpreted as specific evidence of HPV-driven disease. ScienceDirectScienceDirectVulvar Intraepithelial Neoplasia - an overview

Surgery is the primary treatment modality for vulvar cancer and generally includes resection of the primary tumor with inguinofemoral nodal staging. BMJ+1BMJPrimary vulvar squamous cell carcinomas with high T ...WileyComprehensive management of vulvovaginal cancers - 2025 The operative plan should be based on biopsy-proven histology and mapped tumor extent rather than visual estimation alone; imaging becomes particularly useful when deep, adjacent-organ, or nodal involvement may alter the operation. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics

For vulvar high-grade squamous intraepithelial lesion rather than invasive carcinoma, simple excision with 5-mm margins and 4-mm depth is described as the most common approach. WileyWileyCancer of the vulva: 2025 update - Obstetrics and Gynecology Do not extrapolate this HSIL excision specification to an invasive tumor without an invasive-cancer operative plan, because invasive vulvar carcinoma requires primary resection and consideration of inguinofemoral staging. BMJ+2BMJPrimary vulvar squamous cell carcinomas with high T ...WileyComprehensive management of vulvovaginal cancers - 2025WileyCancer of the vulva: 2025 update - Obstetrics and Gynecology

When primary surgery cannot reliably address locoregional disease, multidisciplinary planning should integrate the anatomic findings from MRI, CT, or PET with the anticipated morbidity of resection and nodal treatment. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics Radical local resection and inguinal node excision are established components of treatment, with chemotherapy and radiation used in selected circumstances. BMJBMJPrimary vulvar squamous cell carcinomas with high T ...

Inguinofemoral nodal staging is integral to the surgical management of invasive vulvar cancer. BMJ+1BMJPrimary vulvar squamous cell carcinomas with high T ...WileyComprehensive management of vulvovaginal cancers - 2025 In selected early-stage settings, sentinel lymph node biopsy provides a less morbid alternative to full inguinofemoral lymphadenectomy, but it must be performed with rigorous mapping and pathology because false-negative sentinel nodes can present as groin recurrence with a higher risk of mortality. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer

A sentinel-node strategy using technetium-99m and blue dye with hematoxylin-and-eosin histopathology, followed by ultrastaging and immunohistochemistry for initially negative nodes, was modeled as an effective approach for two-year survival free of morbidity. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer The same analysis identified technetium-99m mapping with ultrastaging after negative H&E assessment as the most cost-effective strategy for survival free of long-term morbidity over two years. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer

Counsel patients that lymphedema is a clinically meaningful long-term tradeoff of inguinofemoral lymphadenectomy; it has greater quality-of-life impact than sentinel-node biopsy in comparative analyses. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer Conversely, a negative sentinel-node result does not eliminate the need for surveillance, because false-negative mapping may be followed by groin recurrence within the two-year period used in the analysis. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer

For disease in which examination raises concern for extensive local spread, bulky nodal disease, or distant metastasis, obtain MRI, CT, or PET before committing to definitive surgery. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics These modalities are used to determine disease extent and should be incorporated into treatment planning when the procedure required for complete resection may be extensive. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics

Vulvar squamous cell carcinoma treatment may include radical resection of the primary tumor, excision of inguinal lymph nodes, and, in some circumstances, chemotherapy or radiation. BMJBMJPrimary vulvar squamous cell carcinomas with high T ... Use multidisciplinary gynecologic-oncology, radiation-oncology, pathology, and radiology review when imaging or operative findings suggest that local control will require combined-modality treatment. BMJ+2BMJPrimary vulvar squamous cell carcinomas with high T ...ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics

Do not assume that a molecular alteration predicts meaningful benefit from a genome-targeted therapy in advanced cancer. Across NCCN-recommended genome-targeted therapies for metastatic cancers, only about one eighth were classified as having a high likelihood of benefit and approximately one third as promising but unproven by ESMO frameworks. BMJBMJClinical value of guideline recommended molecular targets ... If considering biomarker-directed or immune therapy in advanced vulvar cancer, interpret biomarkers in the context of tumor type, treatment setting, and established drug-specific evidence rather than using broad gynecologic-cancer biomarker associations alone. BMJBMJSociety for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of gynecologic cancer | Journal for ImmunoTherapy of Cancer

After surgical treatment, perform focused vulvar and groin examination at follow-up visits and promptly biopsy a new or suspicious lesion rather than relying on visual impression alone. ScienceDirectScienceDirectVulvar Intraepithelial Neoplasia - an overview This is particularly important after sentinel-node staging because false-negative nodal assessment can lead to groin recurrence, and the two-year horizon has been used because such recurrences would be expected to declare themselves within that interval. NatureNatureCost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer | British Journal of Cancer

When surveillance identifies a suspicious groin finding or a lesion whose local extent cannot be reliably assessed clinically, use MRI, CT, or PET to restage anatomy before salvage planning. ScienceDirect+1ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics The decision should then return to the same core branches: feasibility of local resection, requirement for regional nodal management, and need for radiation or chemotherapy as part of a multimodality strategy. BMJ+2BMJPrimary vulvar squamous cell carcinomas with high T ...ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics

Interpret survival estimates cautiously at the individual level because stage and age influence outcomes in vulvar cancer. BMJBMJInfluence of stage and age on survival of patients with ... These variables should inform prognostic counseling but should not replace tumor-directed assessment of local extent, regional nodes, and treatment feasibility. BMJ+2BMJInfluence of stage and age on survival of patients with ...ScienceDirectSurgical management of squamous cell vulvar cancer ...pubs rsnaCarcinoma of the Vulva | RadioGraphics