Current trends in the management of vulvar carcinoma

: Recent establishment of a radical surgery for primary vulvar carcinoma and regional lymph nodes resulted in higher 5-year survival rates, although it was regarded as a fatal malignancy in the early part of the twentieth century. These changes, however, came at the great cost of significant physical and psychological morbidity. Over the past 20 years, numerous refinements of the standard management for vulvar carcinoma have been made, from the standpoint of QOL. The refinements include 1) Individualization of care for all patients; 2) Vulvar conservation for unifocal primary tumors; 3) Omission of groin dissection for T1 lesions < or = 1 mm deep; 4) Elimination of routine pelvic lymphadenectomy; 5) Modifications to the groin dissection, including use of separate incision and preservation of fascia lata and saphenous vein; 6) Unilateral groin dissection for lateral T1 lesions with negative ipsilateral nodes; 7) Preoperative radiation to avoid pelvic exenteration for patients with advanced disease; 8) Postoperative radiation for positive groin nodes; 9) Preoperative chemoradiation for patients with advanced disease; and 10) Elimination of groin dissection using sentinel lymph node procedure. In this review, the author interprets the evidences from which the above changes were derived and discusses some discrepancies.