Vulvar Cancer Clinical Practice Guidelines (ESGO, 2023)

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 25, 2023

The guideline update on management of vulvar cancer was released on June 27, 2023 by the European Society of Gynaecological Oncology.[1]

Diagnosis and staging

In any patient with suspected vulvar cancer, diagnosis should be established by a punch/incision biopsy. Excision biopsy should be avoided for initial diagnosis, as this may hinder further treatment planning. In patients with multiple vulvar lesions, all lesions should be biopsied separately with clear documentation of mapping.

Because there is limited alignment between the American Joint Committee on Cancer (AJCC) 8th edition tumor-node-metastasis (TNM) staging and the International Federation of Gynecology and Obstetrics (FIGO) 2021 classification, and lack of evidence to base treatment on the FIGO 2021 staging, TNM classification is advised.


For local treatment, radical local excision is recommended, with the aim to obtain histologic tumor-free margins. Extending the primary excision in a superficial fashion to include adjacent differentiated vulvar intraepithelial neoplasia is highly recommended. In multifocal invasive disease, radical excision of each lesion as a separate entity may be considered.

Postoperative radiotherapy to the vulva is indicated when invasive disease extends to the pathological excision margins of the primary tumor and further surgical excision is not feasible,

Primary chemoradiotherapy is the treatment of choice in patients with unresectable disease and should be considered for tumors that would otherwise need exenterative surgery with stoma formation.

For more information, please go to  Malignant Vulvar Lesions.

For more Clinical Practice Guidelines, please go to Guidelines.


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