Version July 2025
Management of vulvar cancer includes both surgical excision and evaluation of lymph nodes. This algorithm describes the evaluation of the lymph nodes. The extent of the surgical excision is described in a separate algorithm.
It is important to note that lymph node assessment is performed even if radiation therapy is planned. Management of patients in whom surgery is not feasible (eg, lymph nodes fixed to femoral vessels or other pelvic organs) is discussed in related UpToDate content.LND: lymphadenectomy; SLNB: sentinel node biopsy.
* Bilateral lymphadenectomy is performed if unilateral node is positive.
¶ Criteria for SLNB include all of the following: Stage IB or II (refer to inset), no palpable lymph nodes, unifocal disease, and sufficient surgical expertise. Institutions vary regarding tumor diameter from <2 to <4 cm. Patients should be counseled about the risk of a false negative with SLNB.
Δ Depth of invasion is measured from the basement membrane of the deepest, adjacent, dysplastic, tumor-free rete ridge (or nearest dysplastic rete peg) to the deepest point of invasion.
◊ Regional refers to inguinal and femoral lymph nodes.