A 76 - year - old female presented with non - healing ulcer on labia majora for 6 months measuring 2 x 3 cm with no palpable lymphadenopathy. Biopsy shows Squamous cell carcinoma. Management of this patient includes?
Radical vulvectomy with sentinal LN biopsy
Wide excision
Simple vulvectomy
Chemoradiation with resection
Non- Healing Ulcer, 2x3 cm, no palpable lymphadenopathy concludes to stage Ib of Ca Vulva. Staging of Ca vulva Stage I Limited to vulva IA IB Size - < 2 cm, Invasion - < 1 mm Size - < 2 cm, Invasion - > 1 mm Stage II Adiacent organ femoral LN involvement Lower 1/3rdvagina Lower 1/3rdof urethra, anus Stage III Inguinal femoral LN involvement IIIAi Aii One LN - > 5mm One or Two LN - < 5m IIIBi Bii Two LN - > 5mm More than 3 LN - < 5mm III C LN involvement ?, with extra capsular spread Stage IV IV Ai Aii Upper urethra, upper vagina, rectal involvement Growth stuck to pelvic bone Fixed or ulcerated LN IV B Distant metastasis Pelvic LN Treatment: Stage IA- Wide excision Stage I & II- Radical vulvectomy with sentinal LN biopsy If negative- Radical vulvectomy alone If positive- Radical vulvectomy + LN removal Stage III & IV- Chemoradiation with resection