Early invasive carcinoma of the vulva treated with the Mohs technique of microscopically controlled surgery

Carcinoma of the vulva accounts for 3% to 4% of all malignancies of the female genital tract. Approximately 90% of the vulvar cancers are squamous cell carcinomas. The traditional therapy for invasive squamous cell carcinoma of the vulva has been radical vulvectomy with inguinal and possibly pelvic lymphadenectomy. Radical vulvectomy results in substantial morbidity, because vulvectomy is destructive not only of the individual's sexual function but also of body image. From a review of the contemporary literature the argument can be made that there is no unequivocal proof that radical vulvectomy is required for control of limited or early primary squamous cell carcinoma of the vulva. It may be possible to do less without adversely affecting present surgical success rates. Our interest was initiated by referral of a young woman with early vulvar cancer who had refused surgical vulvectomy. We present, in this report, the application of the Mohs surgical technique to early invasive squamous cell carcinoma of the vulva.