ABSTRACT
Stoekel, in his seminal monograph of 1930, outlined every known variant of surgical treatment, many of which have later been “rediscovered” by other experts around the world. Closer to home, Stanley Way, working in Gateshead (UK) in the 1940s, reconfirmed the importance of the lymphatic ray and the drainage of the vulva, and suggested that a wide local excision of the lesion on the vulva should be combined with an extensive dissection of the skin of the suprapubic area and the groin. Unfortunately, although the cure rates for cancer of the vulva improved markedly when radical treatment was adopted, the adverse effects of such massive surgery were that patients spent a considerable time in hospital and were left with large wounds requiring intensive nursing care. Interestingly, the long-term result of these large wounds was frequently a remarkably satisfactory cosmetic effect. As a consequence of the realization that not all patients required such radical surgery, in the latter part of the twentieth century, moves toward individualization of care, first outlined by Stoekel in 1930, were resurrected. It is now common practice to accurately stage the cancer of the vulva with careful measurement, both clinical and pathological, and based on these measurements determine exactly the most appropriate surgical procedure to achieve high cure rates with minimal adverse cosmetic effect.
