USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Management.

Table II-3-1. Management    of  Vulvar  Carcinoma

Radical

vulvectomy

Removes entire  vulva   (subcutaneous   and fatty   tissue, labia

minora  and majora, perineal    skin,   clitoris)

Sexual

dysfunction

Modified    radical

vulvectomy

Wide    local   excision    (for    unilateral  labial  lesions that    do  not

cross   the midline)

Less    sexual

morbidity

Lymphadenectomy Inguinal    node    dissection  (bilateral  if  midline lesions >1  mm

invasion;   unilateral  selectively)

Lower-

extremity

edema

Wide    local   excision    only:   used    only    for stage   IA; risk    of  metastasis  is

negligible  so  no  lymphadenectomy is  needed

Modified    radical vulvectomy: involves    radical local   excision

Ipsilateral inguinal    dissection  is  used    only    if  stage   is  IB  &   unifocal,

lesion  >1  cm  from    midline,    AND no  palpable    nodes

Bilateral   inguinal    dissection  is  used    if  at  least   stage   IB  or  a   centrally

located lesion  OR  palpable    inguinal    nodes   or  positive    ipsilateral nodes

Radical vulvectomy: involves    removal of  labia   minora  &   majora, clitoris,

perineum,   perineal    body,   mons    pubis;  seldom  performed   due to  high

morbidity

Pelvic exenteration.    In  addition    to  radical vulvectomy, it  involves    removal of

cervix, vagina, and ovaries in  addition    to  lower   colon,  rectum, and bladder

(with   creation    of  appropriate stomas);    seldom  indicated   or  performed   due to

high    morbidity.

Radiation   therapy:    used    for patients    who cannot  undergo surgery