Invasive squamous cell carcinoma of the vulva: behavior and results in the light of changing management regimes

EDITORIAL COMMENT: We accepted this paper for publication because detailed analysis of results in 90 cases of invasive carcinoma of the vulva treated by one team of surgeons in a 10-year period provides important information for those who must decide how to treat women with these lesions. The legends to Figure IA and B present an anecdotal case illustrating that even aged women with invasive cancer merit consideration of radical surgery.

Summary: Ninety-nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five-year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.