The International Society for the Study of Vulvovaginal Disease Surgical Oncological Procedure Definitions Committee “Surgical Terminology for Vulvar Cancer Treatment”

Objectives

The International Society for the Study of Vulvovaginal Disease (ISSVD) Surgical Oncological Procedure Definitions Committee propose a consistent terminology based on well-defined and reproducible anatomic landmarks that can be used by all who are involved in care of patients with vulvar conditions.

Materials and Methods

The fundamental principles behind the new terminology contained descriptions of the area extension and depth of the surgical procedure.

Results

Vulvar Surgical Topographic Anatomy Landmarks

Extension. The internal border of the vulva is the hymenal ring. The genitocrural folds are the external lateral borders.

The vertical line through the clitoris and the anus defines lateral portions of the vulva.

The horizontal line from the upper border of the hymenal ring defines anterior and posterior portion of the vulva.

Depth. The floor of the vulva is represented by the median perineal fascia or perineal membrane of the urogenital diaphragm.

A. Vulvectomy

1. Extension: partial/total vulvectomy. Removal of part/entire vulvar/perineal integument independent of the depth.

2. Depth: superficial/deep. Removal of the most superficial layer/removal of the vulvar tissue to the superficial aponeurosis of the urogenital diaphragm and/or pubic periosteum.

B. Inguinofemoral lymphadenectomy

1. Superficial inguinofemoral lymphadenectomy. Removal of the nodes located beside the inguinal ligament and along the great saphenous vein.

2. Deep femoral lymphadenectomy. Removal of the nodes below the cribriform lamina and medial to the femoral vein.

Conclusions

This terminology helps avoid confusion and promote better understanding and exchange of experiences among gynecologic oncologists involved in vulvar carcinoma care.