The management of squamous cell carcinoma of the vulva

Abstract

The purpose of this article is to explain the evolution of the current management of carcinoma of the vulva. Before the 1940s the outlook for a patient with carcinoma of the vulva was extremely poor. A variety of relatively ineffective treatments were practised including coagulation diathermy, radiotherapy and limited non-radical surgery with reported 5-year survivals ranging from 10-25°h.‘-3 Within two decades the outlook had dramatically altered and many centres were reporting 5-year survival rates in excess of 60%. The principal reason for this improvement was the development and application of radical surgery. In 1912, a Frenchman, Antoine Basset, was the first to propose a radical surgical procedure for a carcinoma of the vulva.4 In addition to a wide excision of the primary carcinoma, in this instance a carcinoma of the clitoris, he suggested that the regional lymph nodes should be removed in an en bloc fashion utilizing incisions running parallel with the inguinal ligament (Fig. 1A). Basset only performed his procedure on cadavers and it was Frederick Taussig of St. Louis, Missouri, who performed the first large series of radical surgery. Taussig modified the original Basset operation by making three separate incisions (Fig. lB), fashioning the groin incisions to run obliquely across the line of the inguinal ligament. Stanley Way in Newcastle, England, approached the problem of carcinoma of the vulva in a similar way to Taussig but he felt that an even more radical excision was necessary. He proposed a radical vulvectomy and en bloc inguino-femoral and pelvic node