Diagram of the incisions made in a vulvectomy, a treatment for<unk>  Surgery is a mainstay of therapy depending on anatomical staging and is usually reserved for cancers that have not spread beyond the<unk>  Surgery may involve a wide local excision (excision of the tumor with a safety-margin of healthy tissue, that ensures complete removal of the tumor), radical partial vulvectomy, or radical complete vulvectomy with removal of<unk>  tissue, inguinal and femoral lymph nodes. In cases of early<unk> , the surgery may be less extensive and consist of wide excision or a simple vulvectomy. Surgery is significantly more extensive when the cancer has spread to nearby organs such as the urethra, vagina, or rectum. Complications of surgery include wound infection, sexual dysfunction, edema and thrombosis, as well as lymphedema secondary to dissected lymph nodes. Sentinel lymph node (SLN) dissection is the identification of the main lymph node(s) draining the tumor, with the aim of removing as few nodes as possible, decreasing the risk of adverse effects. Location of the sentinel node(s) may require the use of technetium(99m)-labeled nano-colloid, or a combination of technetium and 1% isosulfan blue dye, wherein the combination may reduce the number of women with "'missed"' groin node metastases compared with technetium only. Radiation therapy may be used in more advanced<unk>  cases when disease has spread to the lymph nodes and/or pelvis. It may be performed before or after surgery. In early<unk> , primary radiotherapy to the groin results in less morbidity but may be linked with a higher risk of groin recurrence and reduced survival compared to surgery. Chemotherapy is not usually used as primary treatment but may be used in advanced cases with spread to the bones, liver or lungs. It may also be given at a lower dose together with radiation therapy. Checkpoint inhibitors may be given in melanoma of the<unk>  There is no significant difference in overall survival or treatment‐related adverse effects in women with locally advanced<unk>  when comparing primary chemoradiation or neoadjuvant chemoradiation with primary surgery. There is a need for good quality studies comparing various primary treatments. Women with<unk>  should have routine follow-up and exams with their oncologist, often every three months for the first 2–3 years after treatment. They should not have routine surveillance imaging to monitor the cancer unless new symptoms appear or tumor markers begin rising. Imaging without these indications is discouraged because it is unlikely to detect a recurrence or improve survival and is associated with its own side effects and financial costs.
Vulvar cancer
Lichen sclerosus
Genital ulcer
Hyperplasia
Amurca
Bartholin's cyst
Anal cancer
Atrophic vaginitis