THERAPEUTIC IMPLICATIONS OF LYMPH NODAL SPREAD IN LATERAL T(1) AND T(2) SQUAMOUS-CELL CARCINOMA OF THE VULVA

From 1963 to 1993, 157 patients with primary squamous cell carcinoma o f the vulva were treated by radical surgery at the University of Kentu cky Medical Center. There were 84 unilateral lesions confined to the l abium majus or labium minus. Thirty-seven patients had T1 lesions, med ian diameter 1.5 cm (range 0.5-2.0 cm), and 47 patients had T2 lesions , median diameter 3.4 cm (range 2.2-9.0 cm). Radical vulvectomy with b ilateral inguinal lymphadenectomy was performed in 56 patients and rad ical hemivulvectomy with selective inguinal lymphadenectomy in 28 pati ents. An average of 8 nodes was removed with superficial inguinal lymp hadenectomy and 13 nodes with superficial and deep inguinal lymphadene ctomy. Deep inguinal lymph node metastases occurred only in patients w ith positive superficial inguinal lymph nodes. There were no contralat eral inguinal lymph node metastases in any lateral T1 or T2 lesion. Fo llowing surgery, patients were followed 1-15 years (mean 5.0 years) an d none have been lost to follow-up. Nine patients developed ipsilatera l recurrences, but no contralateral recurrences were noted. Seven of t hese patients developed local recurrences to the ipsilateral vulvar sk in and were cured by reexcision. Two patients (2.4%), both of whom had positive ipsilateral superficial and deep inguinal lymph node metasta ses at the time of initial surgery, developed distant metastases and d ied of disease 10 and 11 months after treatment. These data suggest th at deep inguinal lymph nodal metastases occurred only in patients with superficial inguinal node involvement. Contralateral inguinal lymph n odal metastases are extremely rare in lateral T1 and T2 vulvar squamou s cell carcinomas. Radical hemivulvectomy is as effective as radical v ulvectomy in the treatment of lateral T1 and T2 vulvar squamous cell c ancers. (C) 1994 Academic Press, Inc.