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Radical vulvectomy

Author
C William Helm, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Historically, the standard operation for the treatment of even a small invasive carcinoma of the vulva was radical vulvectomy with removal of the primary tumor, including a wide area of skin extending onto the medial thigh, groins, and lower abdomen, together with an en bloc resection of the inguinal and often the pelvic lymph nodes [1]. This operation had a high morbidity rate with approximately 50 percent of the wounds experiencing breakdown.

Increasing knowledge and understanding of the disease has allowed surgical procedures for the treatment of carcinoma of the vulva to become more conservative and individualized to each patient. Such procedures include radical hemivulvectomy and radical local excision/resection, but they all must observe the fundamental aim of complete excision of the primary tumor with ideally a minimum 2 cm surgical margin [2,3] and dissection down to the level of the deep fascia of the thigh and/or the periosteum of the pubis and the inferior fascia of the urogenital diaphragm.

Although adenocarcinoma of the vulva is treated in much the same fashion as squamous cell carcinoma, involvement of Bartholin gland is still thought to require total radical vulvectomy. The management of malignant melanoma remains controversial. (See "Bartholin gland masses: Diagnosis and management" and "Initial surgical management of melanoma of the skin and unusual sites".)

The exact procedure used depends upon the site, size, and histologic features of the tumor (picture 1). The clitoris may be preserved if the tumor is situated posteriorly on the vulva or lies 2 cm or more from the clitoris or closer in selected cases [4-6].

When a groin node dissection is planned it is usually performed first, unless the patient's medical condition is uncertain; in such patients it is best to excise the vulva tumor first in case the anesthetic has to be abandoned.

                    
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Literature review current through: Nov 2017. | This topic last updated: Dec 04, 2017.
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References
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