title: The treatment of lateral T1 and T2 squamous cell carcinomas of the vulva confined to the labium majus or minus.
abstract: OBJECTIVE
  To determine the pattern of lymph node metastases, recurrence rate, and survival of patients with lateral T1 and T2 squamous cell cancer (SCC) of the vulva treated by radical vulvectomy or hemivulvectomy and inguinal lymphadenectomy.
  
  
  METHODS
  An institutional review was performed to identify lateral T1 and T2 SCC of the vulva confined to the labium majus and minus.
  
  
  RESULTS
  Sixty-one patients with lateral T1 and 61 patients with lateral T2 SCC of the vulva were treated from 1963 to 2003. Radical vulvectomy (RV) was performed in 60 patients, and radical hemivulvectomy (RHV) in 62 patients. Seven of 61 patients (11%) with T1 lesions had ipsilateral superficial inguinal lymph node (SIL) metastases, but none had deep inguinal lymph (DIL) node metastases. Nineteen of 61 patients (31%) with T2 lesions had ipsilateral SIL metastases, and 8 had ipsilateral DIL metastases. No patient had contralateral SIL or DIL metastases. Six patients (10%) with T1 lesions and seven patients (11%) with T2 lesions developed recurrence to the ipsilateral vulva and were treated by re-excision. All patients are alive with no evidence of disease 10-195 months after treatment. One patient with T1 and three patients with T2 SCC developed distant recurrence and died of disease (DOD) 10-15 months after surgery. Disease-free survival of patients with T1 lesions was 98% at 2 years and 98% at 5 years, and with T2 lesions was 95% at 2 years and 93% at 5 years. Local or distant recurrence was not more common in patients treated by RHV than in those treated by RV.
  
  
  CONCLUSIONS
  Lateral T1 and T2 squamous cell cancers of the vulva spread to the ipsilateral inguinal lymph nodes and can be treated effectively with RHV and ipsilateral SIL dissection. Deep inguinal lymphadenectomy is indicated only when the SIL are positive.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center-Markey Cancer Center, 800 Rose Street, 333 Whitney-Hendrickson Building, Lexington, KY 40536-0298, USA. cpd12@alltel.net
authors.forename: Christopher P
authors.initials: CP
authors.lastname: DeSimone
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Van Ness
authors.forename: Amy L
authors.initials: AL
authors.lastname: Cooper
authors.forename: Susan C
authors.initials: SC
authors.lastname: Modesitt
authors.forename: Paul D
authors.initials: PD
authors.lastname: DePriest
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Ueland
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Pavlik
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kryscio
authors.forename: John R
authors.initials: JR
authors.lastname: van Nagell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*