In the setting of vulvar cancer, do you perform complete inguinal lymphadnectomy when inguinal sentinel nodes demonstrate micrometastatic (<2mm) disease?

Knowing the status of the groin nodes is critical in vulva cancer, as it has important prognostic value and is considered when tailoring adjuvant therapy. Methods chosen to assess the groin must consider morbidity vs. accuracy. I favor imaging patients pre-operatively with PET/CT if and when possible. Inguinal lymphadenectomy is indicated in vulvar tumors with a depth of invasion greater than 1 mm. Patients with unifocal tumors that are 2cms or less in size but have a depth of invasion greater than 1mm, and unifocal tumors that are greater than 2 cms but less than 4 cms can be candidates for sentinel lymph node sampling in the absence of palpable groin nodes or suspicious nodes on imaging.

During the sentinel lymph node mapping, three scenar...