• Surgical/pathological staging of primary vulvar squamus cell carcinoma and melanomas
• Major determinant for the extent of inguinofemoral lymph node dissection
• Guiding the necessity for adjuvant groin/pelvic radiotherapy

• Groin node status is the single most important prognostic factor for overall survival.
• Note that pelvic lymph node involvement (iliac/obturator) bypasses Stage III completely and is classified as Stage IVB (distant metastasis).
• Stage IA patients have an essentially zero risk of nodal metastases. They strictly require wide local excision only and should be spared the severe morbidity of groin dissection.

• Stage IA: Wide local excision (WLE). Observation of groins.
• Stage IB / II (Lateral tumor, >2cm from midline): WLE + ipsilateral inguinofemoral lymph node evaluation (or Sentinel Lymph Node biopsy).
• Stage IB / II (Central tumor, <2cm from midline): WLE + bilateral inguinofemoral lymph node evaluation.
• Positive Sentinel Node or ECS: Proceed to full genitofemoral lymphadenectomy and immediate planning for adjuvant groin/pelvic radiotherapy.

Prior to the 1990s, vulvar cancer was uniformly treated by the brutal "en bloc" radical vulvectomy with bilateral groin dissections. Modern staging allows for highly targeted, tissue-sparing surgery to prevent catastrophic lymphedema while maintaining survival rates.