Traditionally, large amounts of tissue were removed in a 'radical vulvectomy'. This involved the removal of the entire vulva and the inguinofemoral lymph nodes on both sides with what was termed a “butterfly” incision. Patient survival was correlated to this surgery, sometimes described as "mutilating". In the past two decades individual treatment plans have replaced the standardized "butterfly" surgical techniques. Removal of the inguinofemoral lymph nodes is done separately from the vulvectomy.
Lymphatogenous metastasis
Metastasis
Diastasis 
Tumor progression
Micrometastasis
Vascular tumor
Bone metastasis
Radiation-induced cancer