title: Modern management of vulvar cancer.
abstract: OBJECTIVE
  The radical surgical approach in the treatment of vulvar cancer patients has led to a favourable prognosis for the majority of patients with early stage vulvar cancer. However, morbidity is impressive, leading to more individualized treatment. The authors have reviewed the most recent literature on the pros and cons of the modifications in treatment, including surgery and primary radiotherapy, for primary squamous cell carcinoma of the vulva and vulvar melanoma.
  
  
  RESULTS
  The sentinel lymph node procedure is a promising method of staging in patients with early stage squamous cell carcinoma of the vulva and possibly for patients with vulvar melanoma, but its safety still has to be proved. Less radical surgery has led to a higher local and regional recurrence rate. There may be a role for primary radiotherapy of the groin in a selected group of patients.
  
  
  CONCLUSIONS
  The authors have concluded that the individualization of treatment for vulvar cancer patients has led to a decrease in morbidity but an increase in recurrences. The increase in recurrences does not appear to compromise prognosis, probably because of the lack of power, based on the low incidence of vulvar cancer. The sentinel lymph node procedure and primary radiotherapy are promising methods to reduce the morbidity of treatment but their safety needs to be studied in randomized trials.
authors.affiliation: Department of Gynecologic Oncology, University Medical Centre Nijmegen, Nijmegen, The Netherlands. j.dehullu@obgyn.umcn.nl
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
authors.forename: Maaike H M
authors.initials: MH
authors.lastname: Oonk
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
mesh_terms: D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D021701:Sentinel Lymph Node Biopsy; D014846:Vulvar Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*