Skin bridge recurrences in vulvar cancer: frequency and management.
Rose PG. Skin bridge recurrences in vulvar cancer: frequency and management. The use of separate groin incisions has markedly reduced the rate of wound breakdown from radical vulvectomy. This retrospective review was undertaken to evaluate the frequency and management of skin bridge recurrences. Five cases of skin bridge recurrence in vulvar cancer were identified among 128 patients. Patient demographics, pathology, recurrence management, and follow-up were obtained from operative and clinical records and tumor registries. Five cases of isolated skin bridge recurrence were studied, of which four patients had squamous cancer and one melanoma. Excluding one case referred at recurrence, this occurred in 2.4% of patients with squamous cell carcinoma and was more common in patients with positive nodes 3 of 41 patients versus 0 of 85, relative risk 3.07 (95% confidence interval 2.39-3.95). The median time to recurrence following surgery was 4.0 months (range 1-47 months). Four recurrences were treated by radical local excision alone, but 3 had already received radiation therapy. One patient developed a second skin bridge recurrence and was treated with a second radical local excision. Three patients are alive and recurrence-free 38+ to 56+ months (median 51+ months) following treatment for recurrence. Skin bridge recurrences are rare and more common in patients with inguinal node metastasis. Local excision with or without radiation therapy is the most common therapy that has been employed. In the absence of other metastases local excision is associated with a good recurrence-free survival.
The Division of Gynecologic Oncology, Department of Reproductive Biology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio.
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Rose