Surgical therapy of vulvar carcinoma consists of vulvectomy/hemivulvectomy plus inguinofemoral lymphadenectomy [1, 2]. Patients affected by small well-lateralized lesions can be treated by omolateral groin lymphadenectomy; in case of positive omolateral inguinal nodes, median lesions and/or carcinomas C2 cm, bilateral groin lymphadenectomy should be performed [1, 2]. Also in patients affected by vulvar cancer with multiple lymph node metastases, radical surgery followed by chemotherapy is a feasible strategy, with an acceptable short and long term complication rate and result in terms of overall survival and disease-free survival is promising [3]. However, radical surgery may compromise anatomical structure causing severe mutilation. That’s why chemotherapy, with or without concomitant radiotherapy starts to be strongly recommended either as neoadjuvant strategy or adjuvant treatment [4]. On the other hand, treatment of recurrent disease is not well standardized and no clear indications for lymphadenectomy are proposed. A 70-year-old patient presented at our Institution with vulvar cancer sited in the right labium major. Abdominopelvic computed tomography (CT) scan and chest X-ray were negative for disease. She underwent right modified hemivulvectomy plus omolateral groin lymphadenectomy, with a skin incision parallel to the inguinal ligament above the inguinal cutaneous fold [5]. Histology showed a moderately differentiated squamous vulvar carcinoma of 1.7 cm, and 5 mm depth of invasion, fully excised, with negative margin, measured in microscopic view 2 cm [6] and negative nodes. No adjuvant treatment was proposed. After 6 years of negative follow up, the patient presented recurrent cancer measuring about 1 cm sited again in the right hemivulva. Total body CT scan was negative for distant metastasis. Patient underwent surgical removal of recurrence. Histology showed a moderately differentiated squamous carcinoma of 0.8 cm with negative margins. No further treatment was proposed. One year later patient was admitted with fever and an abscess sited at the level of the left groin. CT scan revealed left inguinal confluent abscessed lymphadenopathy, strictly adherent to femoral vessels and nerves. Biopsy of the mass confirmed abscessed groin nodal relapse from vulvar carcinoma and culture results were positive for Pseudomonas aeruginosa. No vulvar lesions were detected (Fig. 1). In few days, the patient died of sepsis and bleeding. The management of local relapse of vulvar carcinomas should be individualized. Many authors have reported good results when a local excision with adequate resection margins is performed [7]. However, no clear indications for lymphadenectomy are reported. The present case suggests that, in recurrent disease, even in case of good lateralized lesions, contralateral lymphadenectomy should be considered. Iversen et al. [8] reported the presence of contralateral lymphatic drainage in 67 % of patients after injection with 99mTc-colloid in different areas of the vulva. Indeed, in selected cases of recurrent disease, such as the above discussed, the sentinel lymph node procedure can be helpful to better plan the surgical approach. Moreover, Bellati et al. demonstrated the frequent expression of cancer testis tumour associated antigens I. Palaia (&) M. Giorgini M. Graziano V. Di Donato C. Marchetti A. Musella P. Benedetti Panici Department of Obstetrics and Gynecology, ‘‘La Sapienza’’ University, Rome, viale del Policlinico 155, 00155 Rome, Italy e-mail: innocenza.palaia@uniroma1.it