Objectives Vulvar carcinoma (VC) is a rare condition: there is a lack of evidence on treatment in Very Elderly (VE) patients. Aim of the study is to evaluate outcome of surgical resection of VC in the VE population (80 or more years).

Methods Age at diagnosis, FIGO stage, surgical management, groin involvement, site of relapse, disease free survival and overall survival (OAS) were collected for each patient.

Results 32 patients were managed between 2000 and 2020. Mean age at diagnosis was 82.8 years [80–92 years]. Surgical treatment consisted of radical vulvectomy in 22 (68.7%) cases and wide local excision in 10 (31.3%). All patients underwent groin node dissection: 17 (53.2%) monolateral, 15 (46.8%) bilateral. FIGO stage was I in 18 cases (56.3%), II in 1 case (3.1%), 12 had positive nodes (stage III) (37.5%) and 1 case had stage IV (3.1%). Adjuvant radiotherapy was delivered in 5 patients (15.6%). Most common complication was wound breakdown that occurred in 2 cases (6.3%). 15 patients (46.9%) were lost at follow-up. 5 vulvar and groin recurrences were observed (29.4%). Median time to relapse was 21 months [5–47]. Mean OAS was 59.9 months for patients with negative nodes and 13 months for those with positive nodes. Overall survival for the entire group was 35 months [2–148] and 7 (21.9%) patients are alive without evidence of disease.

Conclusions Surgical management of VC is feasible even in the VE population. Complication rate is acceptable, groin dissection appears to have a prognostic rather than a therapeutic purpose.