A 76 - year - old female presented with non - healing ulcer on labia majora for 6 months measuring 2 x 3 cm with no palpable lymphadenopathy. Biopsy shows Squamous cell carcinoma. Management of this patient includes?
(A) Radical vulvectomy with sentinal LN biopsy (B) Wide excision (C) Simple vulvectomy (D) Chemoradiation with resection
(A) Non- Healing Ulcer, 2x3 cm, no palpable lymphadenopathy concludes to stage Ib of Ca Vulva. Staging of Ca vulva Stage I Limited to vulva IA IB Size - < 2 cm, Invasion - < 1 mm Size - < 2 cm, Invasion - > 1 mm Stage II Adiacent organ femoral LN involvement Lower 1/3rdvagina Lower 1/3rdof urethra, anus Stage III Inguinal femoral LN involvement IIIAi Aii One LN - > 5mm One or Two LN - < 5m IIIBi Bii Two LN - > 5mm More than 3 LN - < 5mm III C LN involvement ?, with extra capsular spread Stage IV IV Ai Aii Upper urethra, upper vagina, rectal involvement Growth stuck to pelvic bone Fixed or ulcerated LN IV B Distant metastasis Pelvic LN Treatment: Stage IA- Wide excision Stage I & II- Radical vulvectomy with sentinal LN biopsy If negative- Radical vulvectomy alone If positive- Radical vulvectomy + LN removal Stage III & IV- Chemoradiation with resection