A woman is found to have a unilateral invasive carcinoma of vulva that is 1 cm in diameter with no stromal invasion and is not associated with evidence of lymph node spread. Initial management should consists of :

The patient in question appears to have vulval cancer with stage 1A with unifocal lateral lesion VULVAL CARCINOMA: STAGING AND MANAGEMENT STAGE 1 1A Limited to vulva/perineum Size<=2cm stromal invasion <=1mm Wide local excision + sentinel lymph node study 1B Size >2cm stromal invasion >1mm Radical local excision plus * B/L LAD: central lesion * U/L LAD: lateral lesion (>2cm from midline) STAGE 2 Any size ,Spreads to lower 1/3 urethra, lower 1/3 vagina, anus Early: radical excision/ radical vulvectomy plus B/L LAD Advanced: radiation + surgery + LAD STAGE 3 Positive inguinofemoral lymph nodes Radiation + surgery + LAD STAGE 4A 4B Upper urethra, upper vagina, bladder, rectum, pelvis side wall Distant metastasis, Pelvic or other lymph nodes Radiation + surgery + LAD LAD= lymphadenectomy Radical local excision: excision of entire tumour with at least 1 cm grossly negative margin and extended down to inferior fascia of urogenital diaphragm. Senrinel lymph nodes studies: reliable and suitable in early stage disease with unifocal lesion less than 4 cm and clinically negative lymph nodes on groin examination and imaging.