Superficially invasive stage IA vulvar squamous cell carcinoma—therapy and prognosis

Abstract

ObjectivesSuperficially invasive stage IA squamous vulvar cancer (VSCC) is defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm (FIGO stage IA). This article examines the natural course and prognosis of superficially invasive VSCC.MethodsThis is a retrospective case series of 46 patients (median age 58 years) with superficially invasive stage IA VSCC receiving wide local excision between January 1996 and November 2014 in the University Medical Center Hamburg-Eppendorf.ResultsMedian tumor size was 4 mm. In 39/46 (84.8%) patients peri-tumoral high-grade intraepithelial neoplasia (HSIL) and/or lichen sclerosus (LS) of the vulva were histologically detected: 34 (74.0%) usual type high-grade vulvar intraepithelial neoplasia (uVIN, HSIL), 4 (8.7%) LS with simultaneous VIN (3 uVIN, 1 differentiated VIN (dVIN)), 1 (2.2%) with LS only. 37/46 (80.4%) patients had a R0 resection; in 2 (4.3%) a high-grade VIN was detected in the margin and in 7 (15.2%) the resection status was unknown. The mean follow-up was 58 (range 10–185) months. Four patients (8.7%) suffered from an invasive recurrence after 4, 17, 40, and 54 months, three in the vulva and one in the groin. All local recurrences occurred in women with LS in a combination with high-grade VIN (3 uVIN, 1 dVIN). Two were treated surgically again including inguino-femoral lymphadenectomy (ifLAE) (no regional lymph node metastasis histologically) as invasion depth exceeded 1 mm. The third patient refused treatment. Inguinal recurrence was treated with a bilateral ifLAE, revealing one positive lymph node, followed by adjuvant radiotherapy (groins, pelvis). None of these patients had experienced further recurrences at last follow-up.ConclusionsSuperficially invasive VSCC is characterized by having a very good prognosis. Sole surgical therapy is highly effective. Patients with LS might benefit additionally from intensified surveillance and adequate maintenance therapy in specialized centers.

Superficially Invasive Vulvar Squamous Cell Carcinoma: A 37-Year-Long Experience of a Tertiary Referral Center

“…Our case series confirmed that vulvar SISCCA is a rare entity with good prognosis, and, according to guidelines, surgical local excision without groin lymphadenectomy is a safe and effective treatment. However, we observed a higher relapse rate (21%) compared to the two other series of SISCCA [15,16] reported in the literature (8.7% and 5.9%, respectively).…”

“…Focusing on SISCCA, Grimm et al [15] reported the presence of lichen sclerosus and dVIN in all four reported recurrences. Similarly, in our series, dVIN was found in all patients who relapsed, but no significant differences were found with non-recurrent patients.…”

“…The risk of nodal recurrence is very low in SISCCAs-to date, only 12 cases of SIS-CCA with regional lymph node recurrence have been reported [15,[43][44][45][46][47][48][49][50][51]. There is no specific histopathological pattern predicting nodal involvement and thus allowing tailored management.…”

“…Regarding the treatment for SISCCA, wide local excision or vulvectomy without groin lymphadenectomy are safe and effective therapeutic options, as the risk of nodal metastasis in stage IA is extremely low (<1%). However, few case series of SISCCA are reported in the literature, and thus available data regarding this rare entity are limited [15,16].…”

A short review of current implementations of sentinel lymph node mapping in gynecologic cancers

“…The primary tumor should be resected with at least 1 cm clear margins and either unilateral or bilateral inguinofemoral lymph nodes or in selected patients SLNs should be removed. There is no need for inguinofemoral lymphadenectomy for stage IA patients since risk for nodal involvement is <1% ( 38 ). But patients with stage IB or higher stages have ≥8% risk of nodal metastasis and lymphadenectomy is mandatory ( 39 ).…”