Objectives Vulvar malignant melanoma (VMM) is a rare type of cancer, accounting for 5% of all vulvar malignancies. Surgical treatment consists of wide local excision plus elective lymph node dissection (ELND) or sentinel lymph node (SLN). VEIL is an alternative approach for the radical resection of inguinal lymph nodes, which can reduce the morbidity of the ELND without compromising the therapeutic efficacy. We show the surgical procedure VEIL for VMM.
Methods 70-year-old woman with ulcerated malignant melanoma of 1.5 cm, central, vertical growth, Breslow 8 mm, without lymphovascular or perineural invasion, with negative PET/scan for metastatic lesions, radical hemivulvectomy plus bilateral SLN was made, obtaining mapping only from the right sentinel node, therefore, VEIL was performed on the left side.
Results Previous infiltrate with technetium-99, we detected with gamma sonda right inguinal sentinel lymph node and was resected. Then, we perform left VEIL. Incision of 1 cm on the vertex of the scarp´s trianglewith insertion of trocar of 10 mm; insertion of trocar of 5 mm in medial and lateral aspect and insufflation with C02 was carry out. Repair points: greatsaphenous vein and its tributaries (inferior epigastric vein, external iliac vein, left pudenda vein and accessory saphenous vein) was identified. Inguinal lymphadenectomy was performed over the fascia and below the inguinal ligament, then radical hemivulvectomy was performed.
Conclusions VEIL is an alternative to SLN, less morbid than ELND and feasible as a node dissection of VMM.
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