Vulvar Cancer · Local Excision/Vulvectomy + Inguinal Nodes

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Stage/size/location + groin
   Tumor size/location (midline?)/local invasion? Inguinal nodes?
   • Early T1 (unifocal, <4 cm), lateral (>2 cm from midline), cN0 → Early lateral → wide excision + ipsilateral sentinel
   • Midline lesion or ≥4 cm/multifocal, cN0 → Midline/large → wide excision + bilateral groin
   • Locally advanced (involving distal urethra/vagina/anus) or inguinal node-positive → Locally advanced/node-positive → radical ± chemoradiation
2. [End] Early lateral → wide excision + ipsilateral sentinel
   Early T1 unifocal <4 cm, lateral (>2 cm from midline), cN0 → wide local excision (margin ≥1 cm) + ipsilateral inguinal sentinel lymph node biopsy (sentinel-negative may omit dissection; positive → inguinofemoral lymphadenectomy).
3. [End] Midline/large → wide excision + bilateral groin
   Midline lesion or ≥4 cm/multifocal → wide local excision/partial vulvectomy + bilateral inguinofemoral lymphadenectomy (or bilateral sentinel).
4. [End] Locally advanced/node-positive → radical ± chemoradiation
   Locally advanced (involving distal urethra/vagina/anus) or inguinal node-positive → radical vulvectomy ± chemoradiation (organ-sparing, improves resectability), pelvic exenteration in selected cases; multidisciplinary.

Source guidelines & references

• Vulvar cancer management (NCCN/ESGO; margins and inguinal sentinel/node dissection)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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