The principal prognostic factors in cancer of the vulva are the presence or absence of regional lymph node metastases, size and location of the lesion, and the histologic type.

A 5-year survival rate of 75% and a 10-year survival rate of approximately 58% should be expected after complete surgical treatment of primary invasive squamous vulvar cancer. Lymph node status is the most important prognostic variable. Overall, the survival rate for patients with vulvar cancer and negative inguinal-femoral nodes is 90%, whereas rates drop to almost 40% with nodal metastasis. Several authors have reported no deaths from cancer among patients who were found to have negative lymph nodes.

With tumors less than 2 cm in diameter, the incidence of nodal metastases is 10-15%. In general, approximately 30% of patients undergoing surgery will have positive lymph nodes. With nodal metastases, the approximate 5-year cure rates are as follows: 1 node, 94%; 2 nodes, 80%; and 3 nodes or more, less than 15%. Patients who have 3 or more positive lymph nodes in the groin usually demonstrate palpably suspicious nodes preoperatively. These patients have a high incidence of metastases to the pelvic lymph nodes; however, pelvic lymphadenectomy apparently does not improve survival rates. Involvement of contiguous organs such as the bladder or rectum increases the incidence of nodal metastases and worsens the prognosis accordingly.

The cure rate for adequately treated cancer of Bartholin’s gland has not been established. There is a propensity for unresectable local recurrences under the pubic ramus despite a thorough primary operation.

Wide local excision of basal cell carcinoma should be curative. Some authors have reported an approximately 20% recurrence rate after local excision that may represent cases of incomplete excision.

Results of treatment of malignant melanoma are related to the level of penetration of the tumor into the dermis of the vulvar skin or the lamina propria of the vaginal mucosa and to the presence or absence of nodal metastases. The 5-year survival rate ranges from 14-50%, but patients who have metastases to groin lymph nodes have a survival rate below 14%. Amelanotic cutaneous melanomas are particularly virulent tumors. The survival rate for patients with superficial spreading melanomas is much better than for those with the nodular variety, which tend to have a smaller diameter and exhibit aggressive vertical invasion, increased incidence of nodal metastases, treatment failures, and distant recurrences. The most common site of recurrence is at the site of resection or the groin lymph nodes (if not previously resected).

Sarcomas of the vulva tend to recur locally, particularly if the initial resection is not extensive, and metastasize to the liver and lungs.