Controversies in vulvar cancer: Revisiting the margin of error Review
| Authors: | Byrne, M. E.; Leitao, M. M. Jr; Abu-Rustum, N. R. |
| Review Title: | Controversies in vulvar cancer: Revisiting the margin of error |
| Abstract: | Despite an oftentimes radical surgical approach when treating patients with early-stage vulvar cancer, local recurrence occurs in approximately 40% of cases. Surgery in this setting can result in significant morbidity; however, treatment failure is associated with high mortality rates. Historically, many guidelines recommended a tumor-free margin ≥8 mm in the surgical treatment of vulvar cancer, although this is largely consensus-based and supported by a few small retrospective case series. Recently, numerous retrospective studies have found no association between a tumor-free margin of <8 mm and locoregional recurrence. Emerging evidence suggests that the presence of differentiated vulvar intra-epithelial neoplasia and lichen sclerosis at the pathologic margin may also play a role in local recurrence; however, data are retrospective and heterogenous, and the definition of what a “safe” tumor-free margin is remains unclear. However, increasing evidence has failed to demonstrate the beneficial role of re-excision or adjuvant radiation in the setting of margins of <8 mm. These additional treatments are associated with significant morbidity and have a negative impact on patients’ quality of life; thus, they should be reserved solely for patients with positive margins. One of the main challenges in finding the ideal tumor-free margin is that the rarity of vulvar cancer makes prospective and randomized controlled trials difficult to conduct. Therefore, it is imperative that we make a concerted effort as a field to collaborate across nations and institutions, promote centralization of care for rare tumors, and prioritize future work to better understand the nature of this disease. © 2025 European Society of Gynaecological Oncology and the International Gynecologic Cancer Society |
| Keywords: | cancer surgery; review; cancer radiotherapy; standard; reoperation; vulvar cancer; randomized controlled trial (topic); medical history; surgical management; vulva cancer; precancer; human; female; tumor-free margin; margin of error |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 35 |
| Issue: | 3 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2025-03-01 |
| Start Page: | 101678 |
| Language: | English |
| DOI: | 10.1016/j.ijgc.2025.101678 |
| PROVIDER: | scopus |
| PUBMED: | 39978137 |
| DOI/URL: | |
| Notes: | Review -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged on PDF -- MSK corresponding author is Nadeem Abu-Rustum -- Source: Scopus |
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