Occasionally, wide local excision is necessary to differentiate a preinvasive lesion from invasive carcinoma. Subtle lesions may be delineated by staining the vulva with toluidine blue or by using colposcopy. Melanomas frequently appear as bluish black, pigmented, or papillary lesions. Risk of lymph node spread is proportional to the tumor's size and depth of invasion. With malignant vulvar melanomas, the risk of metastasis is high.
Risk depends mostly on invasion depth but also on tumor size.
Lesions near the midline require a bilateral inguinal femoral lymph node dissection. 2 cm usually require a radical vulvectomy and bilateral inguinal and femoral lymph node dissection. Usually, a bilateral inguinal femoral lymph node dissection is performed first, followed by radiation therapy, then local radical excision of the tumor or tumor bed. This combined approach can preclude ultraradical or exenterative surgery. All rights reserved.