Squamous Cell Carcinoma of the Vulva Stage IA: Long-Term Results
abstract & commentary
Synopsis: T1 squamous cell carcinoma of the vulva with less than 1 mm of invasion was associated with a low risk of vulvar recurrence.
Source: Magrina JF, et al. Gynecol Oncol 2000;76: 24-27.
Magrina and associates report a retrospective review of 40 patients with T1 squamous cell carcinoma of the vulva and less than 1 mm of invasion. The aim of their study was to evaluate the risk of metastases to lymph nodes and long-term results of radical and modified radical surgery in this patient population. The overall mean follow-up time was 7.6 years. Vulvar recurrence developed in two patients (5-year rate, 5.9%). There were no groin recurrences among 10 patients undergoing groin lymphadenectomy. One of the 30 patients (10-year rate, 6.7%) without groin dissection developed groin metastases at 7.5 years, subsequent to an invasive vulvar recurrence. The five- and 10-year cause-specific survivals were 100% and 94.7%, respectively. Magrina et al conclude that T1 squamous cell carcinoma of the vulva with less than 1 mm invasion was associated with a low risk of vulvar recurrence and no groin metastases. Furthermore, they observed that a low risk of subsequent groin node metastasis exists in patients developing an invasive vulvar recurrence. Long-term follow-up of these patients is recommended. Additionally, lesser forms of vulvar excision, such as wide local excision, were equally effective as radical vulvectomy for the prevention of vulvar recurrences. Patients treated by radical vulvar surgery experienced increased postoperative complications compared with patients treated by less radical surgery.
Comment by David M. Gershenson, MD
Historically, vulvar cancer has been vastly overtreated during the past 50 years. Ultraradical surgery consisting of en bloc radical vulvectomy and bilateral inguinal (and often, pelvic) lymphadenectomy pioneered by Stanley Way in the late 1940s dramatically improved the cure rates of early invasive vulvar cancer. However, major complications—including wound breakdown and severe lymphedema—were common. In addition, sexual function and body image were frequently severely impaired. In the 1970s, several gynecologic oncologists began to pursue the concept of less radical surgery for early vulvar cancers or "microinvasive" lesions. Although early attempts fell short, by the early 1990s, wide radical excision and superficial inguinal lymphadenectomy evolved as standard surgical therapy for stage I invasive and even for stage II invasive vulvar cancer. Intraoperative lymphatic mapping and/or lymphoscintigraphy offer the hope of even less radical surgery in the near future. Amidst these advances, we have also learned, as reflected in this report from the Mayo Clinic, that superficially invasive vulvar cancers with less than 1 mm invasion can be safely treated with wide local excision alone (no associated lymphadenectomy). As noted by Magrina et al, there is a small incidence of recurrent vulvar dysplasia or even new primary vulvar cancer, but these results are consistent with a report from the M.D. Anderson Cancer Center.1 Although not addressed by Magrina et al, I would recommend a 1 cm margin in a wide local excision of lesions with less than 1 mm invasion.
Reference
1. Kelly JL, et al. Gynecol Oncol 1992;44:240-244.
Recommended surgical treatment of a vulvar cancer with less than 1 mm of invasion consists of which one of the following?
a. Wide local excision
b. Wide local excision plus unilateral superficial inguinal lymphadenectomy
c. Modified radical vulvectomy
d. Modified radical vulvectomy plus unilateral inguinal lymphadenectomy
e. Laser ablation
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content