Double identification of sentinel lymph node with indocyanine green and 99m-technetium in vulvar cancer and V-Y flap for vulvar reconstruction

In this video we show the different steps in the approach to a case of vulvar cancer from the first consultation to final treatment. The surgical procedure involved the double location of a sentinel lymph node with indocyanine green (ICG) and with 99m-technetium, followed by vulvectomy and flap reconstruction.

A 43-year-old woman without a relevant past medical history and with no previous sexual relations was referred to us for a second opinion due to a 3 cm vulvar lesion in the left upper third major labia. Despite her age, an extensive area suspicious of lichen sclerosus was presented all over the vulva.

Initial biopsy showed a squamous cervical carcinoma, so we followed the study by vulvar mapping to exclude more invasive carcinoma, which confirmed the extensive lichen sclerosus without local metastases. We confirmed the absence of distant metastases with positron emission tomography-computed tomography and also the metabolic activity of the vulvar tumor.

CITATION  Int J Gynecol Cancer. 2021 Feb;31(2):300-301. doi: 10.1136/ijgc-2020-002066