title: Patterns and frequency of recurrences of squamous cell carcinoma of the vulva.
abstract: OBJECTIVE
  To analyze patterns and frequency of recurrences of squamous cell carcinoma (SCC) of the vulva after wide local excision (WLE) and superficial inguinal lymphadenectomy with separate incisions and to identify prognostic factors for the development of recurrences.
  
  
  METHODS
  Between January 1985 and December 1999, all 125 consecutive patients with primary SCC of the vulva, treated with WLE and superficial inguinal lymphadenectomy, were retrospectively analyzed. Recurrences were registered by localization as: local, skin bridge, groin or distant.
  
  
  RESULTS
  A local recurrence was diagnosed in 29 (23%) patients, 11 (9%) developed a groin and 4 (3%) a distant recurrence. No skin bridge recurrences were identified. The 5 years local relapse-free survival was 70%. After a first local recurrence, 72% of these patients developed a second local recurrence. Adjusted for other predictors, older age (>74 years) is an independent risk factor for local recurrences (HR: 2.38; 95%-C.I.: 1.08-5.23) and stage III/IV cancer for developing groin/distant recurrences (HR: 3.03; 95%-C.I.: 1.0-9.18).
  
  
  CONCLUSIONS
  WLE and superficial inguinal lymphadenectomy with separate incisions result in a high groin recurrence rate in this study; superficial lymphadenectomy should be replaced by deep inguinofemoral lymphadenectomy. After a local recurrence, 72% of the patients developed a second local recurrence. These patients are at high risk and need a close follow-up.
authors.affiliation: Department of Gynaecological Oncology CMC V, University Medical Center Groningen, University of Groningen, 4th floor, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Jorien M
authors.initials: JM
authors.lastname: Woolderink
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.forename: Joanne A
authors.initials: JA
authors.lastname: de Hullu
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Davy
authors.forename: Ate G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Marian J E
authors.initials: MJ
authors.lastname: Mourits
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery*