Treatment of Unifocal Squamous Cell Carcinoma of the Vulva <4 cm with Depth of Invasion >1 mm and No Suspicious Inguinofemoral Nodes
This protocol covers the management of unifocal squamous cell carcinoma (SCC) of the vulva measuring less than 4 cm, with a depth of invasion greater than 1 mm (beyond T1a staging), in patients who present without clinically or radiologically suspicious inguinofemoral lymph nodes.
Clinical Scenario
The defining features of this population are a single (unifocal) primary vulvar tumor under 4 cm, pathologically confirmed depth of invasion exceeding 1 mm, and the absence of suspicious regional lymph nodes at presentation. These characteristics place patients beyond T1a and warrant a specific surgical and adjuvant treatment pathway.
Treatment Approach
Post-operative inguinofemoral radiotherapy is part of the treatment strategy in selected cases following surgery, with concurrent radiosensitizing chemotherapy also considered in certain situations.
References
DOI: 10.1136/ijgc-2023-004486
- A SLN procedure is indicated in all patients with a primary unifocal tumor <4 cm with a depth of invasion >1 mm and no suspicious nodes.
- The SLN procedure is recommended in patients with unifocal cancers of <4 cm, >T1a, without suspicious inguinofemoral nodes [II, B].
- Radiotherapy is recommended for cases with more than one metastatic lymph node and/or extracapsular spread [II, A].
- Concurrent radiosensitizing chemotherapy should be considered [IV, B].