%0 Journal Article
%T Challenging the concept of microinvasive carcinoma of the vulva: report of a case with regional lymph node recurrence and review of the literature
%A Jutta Sidor
%A Raihana Diallo-Danebrock
%A Elke Eltze
%A Ralph J Lell¨¦
%J BMC Cancer
%D 2006
%I BioMed Central
%R 10.1186/1471-2407-6-157
%X However, a patient with inguinal lymph node recurrence 21 months after radical vulvectomy for stage IA squamous cell carcinoma was observed.According to a review of the literature, there are five additional cases of metastasizing vulvar cancer with a depth of invasion of less than one millimeter. Therefore, the definition of microinvasive carcinoma of the vulva based on depth of invasion alone may not be as reliable as previously thought and does not rule out inguinal lymph node involvement or recurrence. Consequently, the necessity of inguinal node dissection for microinvasive carcinoma needs to be discussed on an individual basis taking into account the age of the patient as well as the potential morbidity of extended surgery.Invasive vulvar carcinoma of all stages is usually treated by radical vulvectomy and bilateral lymphadenectomy. However, such an extensive surgical procedure has a high morbidity. In younger women, severe psychologic stress is caused by this hugely deforming operation, as sexual function and body image are disturbed. Therefore, over the past twenty years, efforts have been made to individualize treatment and to define a subgroup of patients which may be treated by less radical procedures [1]. It is widely thought that tumors with a depth of invasion of less than one millimeter according to criteria established by Wilkinson et al. [2,3] are sufficiently treated by vulvectomy or wide local excision without lymphadenectomy. However, there are five reports of lymph node metastases in patients with so-called "microinvasive carcinoma of the vulva". The patient reported here also developed inguinal lymph node metastasis after local treatment for squamous cell carcinoma of the vulva with a depth of invasion of less than one millimeter.An 80-year-old white female was referred for evaluation of a suspicious vulvar lesion in September of 1997. At that time, the patient was free of complaints. On physical exam, atrophy of the vulva was seen but without e
%U http://www.biomedcentral.com/1471-2407/6/157