Lymph gland metastases in invasive squamous cell cancer of the vulva.

Cancer of the vulva has responded to surgical therapy. "The problem now is to decide in what way the results may be improved." A clinical series of 195 patients who had extended vulvectomy and bilateral inguinal and pelvic lymphadenectomy were systematically examined for lymph gland metastases in the inguinal and pelvic regions. Forty-one patients had metastases in these lymph glands. Lesion site, lesion size, and patterns of metastases were delineated in these 41 patients. ;ariations in the pattern of central (clitoral) and lateral (labial) cancers were recorded. Risk factors of 20.5 and 4.6 per cent respectively, was calculated for omitting bilateral inguinal and pelvic lymphadenectomy. The latter figure indicated that one of 20 patients would have had residual disease if pelvic lymphadenectomy had been omitted. With out present inability to determine accurately lymph gland metastases by nonsurgical means, trends from this study indicate that optimum therapy requires addition of pelvic lymphadenectomy to extended vulvectomy and bilateral inguinal lymphadenectomy.