Sixty-four cases of stage I vulvar squamous cell carcinoma were analyzed histologically to define a patient subset at minimum risk for recurrence or nodal metastases. Three patterns of invasion were predefined: carcinoma in situ with early stromal invasion (33%), pushing (8%), and infiltrative (59%). Infiltrative pattern and invasion deeper than 1.5 mm equally predicted nodal metastases (P = .045), although depth measurement in biopsy specimens was subject to sampling error. Confluence and absence of carcinoma in situ each predicted extranodal recurrence (P = .011). Local recurrence appeared more related to inadequate surgical margins than failure to perform radical vulvectomy. Carcinoma in situ with early stromal invasion represents a group at zero risk for nodal metastases. We recommend wide local excision for all stage I lesions. In general, omission of lymphadenectomy should be reserved for cases of carcinoma in situ with early stromal invasion.
© 1987 The American College of Obstetricians and Gynecologists