Vulvar Cancer Local Recurrence: What to Do When Radical Excision Fails to Achieve Clear Margins
This protocol addresses the management of local (vulvar or perineal) recurrence of squamous cell carcinoma of the vulva — specifically the step taken when prior surgical treatment of the recurrence has not achieved the required oncological outcome.
Clinical Scenario
Local or perineal recurrence of squamous cell carcinoma of the vulva, requiring further management decision-making after initial recurrence surgery.
Escalation Trigger — Why This Protocol Applies
The preceding step — radical local excision of the recurrent vulvar tumour (with surgical groin re-staging where clinically indicated) — did not achieve its primary goal: histological tumour-free surgical margins of the vulva. This failure to clear margins is what escalates management to the current protocol.
Next-Step Approach (Overview — Partial)
The strategy depends on margin status and extent of disease. When margins remain involved, the approach centres on further intervention — either surgical or radiotherapy-based. For patients with locally advanced disease who have not previously received radiotherapy, a definitive combined modality approach is among the options considered. Additional strategies exist for selected cases. The full decision algorithm, criteria, and sequencing are in the structured protocol.
References
For treatment of vulvar recurrence, radical local excision is recommended [IV, B].
In case of resection of the tumour with involved margins, re-excision (if feasible) or post-operative radiotherapy is recommended [IV, B].
In locally advanced disease, definitive (chemo)radiotherapy is recommended in radiotherapy-naive patients. In selected cases, pelvic exenteration can be considered [IV, B].
DOI: 10.1136/ijgc-2023-004486
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