••• Chapter 48^ Vulvar and Vaginal Carcinoma^475
❍ Does recurrence of vulvar cancer in the groin have a good prognosis?
No. Unanticipated recurrence in the groin is almost universally fatal.
❍ What are the major prognostic factors in vulvar cancer?
Tumor size, depth of tumor invasion, nodal spread, and distant metastasis.
❍ When compared in a randomized prospective study, was radiation to the groin and deep pelvic nodes found
to be superior compared with surgical debulking of the deep pelvic nodes in patients with clinically positive
inguinal nodes in vulvar cancer?
Yes. The 2-year survival rates were 59% compared with 31%.
❍ With a malignant melanoma, when can lymphadenectomy be avoided and is not necessary to complete?
Superficial melanomas (Clark level I–II) as risk of metastatic disease are minimal. A poor prognosis is associated
with Clark level IV–V, thickness >2 mm, or mitotic count > 10 /mm^2.