Recent trends in the management of invasive vulval cancer

Vulval cancer is a rare gynaecological cancer, predominantly seen in postmenopausal women. It accounts for about 4% of gynaecological malignancies. Most women present with vulval symptoms such as a painful lump, ulcer or itching, although some may be asymptomatic. It should be managed in experienced cancer centres where relevant expertise and experience is available to provide multidisciplinary, individualized care. Wide local excision of the lesion, usually with surgical staging of groin nodes through separate incisions is recommended for early disease. Locally advanced vulval cancers require complex and highly individualized treatment, which may be a combination of radical excision with reconstruction with or without radiotherapy. Sentinel lymph node assessment for staging is now standard of care, replacing en-bloc inguinofemoral lymphadenectomy for surgical staging of smaller, early-stage tumours, and groin dissection is omitted in these women if sentinel node biopsy is negative (GROINSS-V I study). Recent GROINSS-V II study has shown that radiotherapy is a safe alternative in patients with sentinel lymph node micro metastases (≤2 mm) with low groin recurrence rate and lower treatment-related morbidity.