Introduction Vulvar Squamous Cell Carcinoma (VSCC) is classified as Human Papilloma Virus Associated (HPV-A) or HPV Independent (HPV-I), with HPV-I VSCC having greater risk of recurrence and poorer survival. Surgical guidelines do not distinguish between the aetiologies and all previous surgical margins publications report the aetiologies together, traditionally recommending a 8 mm pathological margin. This study investigates the impact of resection margins on VSCC first local recurrence stratified by HPV-A and HPV-I subtypes.

Methods A retrospective single centre clinico-pathological case note review of 314 patients treated with primary surgery for VSCC between January 1990 to December 2018. The impact of resection margins on first local recurrence was assessed for HPV-A and HPV-I tumours separately in both univariable and multivariable analyses.

Results Local recurrences occurred in 9/143 HPV-A VSCC (6.3%) compared to 45/171 HPV-I VSCC (26.3%). In HPV-A VSCC, resection margins <8 mm compared to >=8 mm were not associated with local recurrence in univariable analysis (HR 0.63, 95% CI 0.17–2.39, p=0.50). Low case numbers prevented multivariable analysis. In HPV-I VSCC, resection margins <8 mm were associated with increased local recurrence compared to >=8 mm in univariable analysis (HR 1.90, 95% CI 1.05–3.44, p=0.03), but this finding was attenuated in the multivariable analysis (HR 1.55, 95% CI 0.79–3.05, p=0.20).

Conclusion/Implications In HPV-I VSCC, there is some evidence that resection margins may impact local recurrence, but further prospective study is needed. Analysis for HPV-A VSCC was limited by the low recurrence rate. HPV testing may be utilised in VSCC management protocols to individualise treatment.