INDIVIDUALIZATION OF TREATMENT FOR STAGE-I SQUAMOUS-CELL VULVAR CARCINOMA

Abstract

Of 177 cases of invasive squamous cell vulvar cancer, 84 (47.5%) had stage I disease. Patients (77) with stage I disease (91.7%) had stromal invasion of .ltoreq. 5 mm. Correlation between lymph node status and depth of invasion was as follows: .ltoreq. 1 mm, none of 34 (0%); 1.1-2 mm, 2 of 19 (10.5%); 2.1-3 mm, 2 of 17 (11.8%); 3-5 mm, 1-7 (14.3%); and > 5 mm, 3 of 7 (42.9%). Patients (56) had radical vulvectomy for the primary lesion, and 28 had more conservative excision, but the incidence of local invasive recurrence (4%) was the same in each group. None of 58 patients treated with inguinal-femoral lymphadenectomy developed a groin recurrence, but 3 of 26 patients (11.5%) who had omission or modification of inguinal-femoral lymphadenectomy died with groin recurrence within 12 mo. Although some modification of the standard radical vulvectomy is appropriate for the primary lesion in patients with stage I disease, patients with > 1 mm of stromal invasion require at least an ipsilateral inguinal-femoral lymphadenectomy.