The International Society for the Study of Vulvovaginal Disease Surgical Oncological Procedure Definitions Committee “Surgical Terminology for Vulvar Cancer Treatment” Leonardo Micheletti, MD, 1 Hope Haefner, MD, 2 Kamil Zalewski, MD, 3,4 Allan MacLean, MD, 5 Facundo Gomez Cherey, MD, 6 Claudia Pereira, MD, 7 Celeste Sluga, MD, 8 Josep M. Solé-Sedeno, MD, 9 Victor M. Vargas-Hernandez, MD, 10 and Mario Preti, MD 1 Objectives: The International Society for the Study of Vulvovaginal Disease (ISSVD) Surgical Oncological Procedure Definitions Committee propose a consistent terminology based on well-defined and reproducible anatomic landmarks that can be used by all who are involved in care of pa- tients with vulvar conditions. Materials and Methods: The fundamental principles behind the new terminology contained descriptions of the area extension and depth of the surgical procedure. Results: Vulvar Surgical Topographic Anatomy Landmarks Extension. The internal border of the vulva is the hymenal ring. The genitocrural folds are the external lateral borders. The vertical line through the clitoris and the anus defines lateral portions of the vulva. The horizontal line from the upper border of the hymenal ring defines anterior and posterior portion of the vulva. Depth. The floor of the vulva is represented by the median perineal fascia or perineal membrane of the urogenital diaphragm. A. Vulvectomy 1. Extension: partial/total vulvectomy. Removal of part/entire vulvar/ perineal integument independent of the depth. 2. Depth: superficial/deep. Removal of the most superficial layer/removal of the vulvar tissue to the superficial aponeurosis of the urogenital dia- phragm and/or pubic periosteum. B. Inguinofemoral lymphadenectomy 1. Superficial inguinofemoral lymphadenectomy. Removal of the nodes lo- cated beside the inguinal ligament and along the great saphenous vein. 2. Deep femoral lymphadenectomy. Removal of the nodes below the crib- riform lamina and medial to the femoral vein. Conclusions: This terminology helps avoid confusion and promote bet- ter understanding and exchange of experiences among gynecologic oncol- ogists involved in vulvar carcinoma care. Key Words: ISSVD, vulvar neoplasms, vulvar anatomical landmarks, groin anatomical landmarks surgical terminology, vulvectomy, inguino-femoral lymphadenectomy (J Low Genit Tract Dis 2020;24: 62–68) BACKGROUND The primary goal of the International Society for the Study of Vulvovaginal Disease (ISSVD), founded in 1970 by a multina- tional group of gynecologists, dermatologists, and pathologists, was to define and promulgate an international nomenclature (ter- minology) for vulvar diseases. These efforts have gone a long way toward recognizing that in the last 20 to 30 years, more specialties (female pelvic medicine and reconstructive surgery, oncology, psychology, physical ther- apy, family medicine, etc.) have been involved in the manage- ment of vulvar diseases. There is a clear need for an ongoing dialog between representatives of the different disciplines in an attempt to arrive at a universal terminology for diagnostic and therapeutic procedures that is accepted, consistently interpreted, and understandable. 1 This has been partially accomplished, and the society currently has in place recently revised terminology and classifications for vulvar dermatoses, 2 vulvar dermatological disorders, 3 vulvar squamous intraepithelial lesions, 4 and persis- tent vulvar pain and vulvodynia. 5 In this article, we explain the deficiencies of the previous vulvar surgical descriptors and pro- pose a consistent terminology based on well-defined and repro- ducible anatomic landmarks that can be used by all who are involved in care of patients with vulvar conditions. THE HISTORY OF SURGICAL TERMINOLOGY FOR VULVAR CANCER For a long time in gynecologic surgery, we have used the terms simple vulvectomy and radical vulvectomy, with every sur- geon having its own full understanding of the procedure. How- ever, the definition may vary from one physician to another and may lead to problems when treatment outcomes are compared. At the Eighth World Congress of the ISSVD in Aland, Finland, in 1985, a task force was appointed to propose a new surgical pro- cedure terminology to provide more precise definitions. The ter- minology was discussed and approved by the ISSVD at the Tenth World Congress, in Washington, District of Columbia, in 1989 and published in 1990. 6 The fundamental principles behind the new terminology contained descriptions of the area (extension) and depth of the sur- gical procedure. It was recommended that these 2 terms be used to describe the operation. A. Vulvectomy 1. Extension 1 Department of Obstetrics and Gynaecology, University of Torino, Torino, Italy; 2 Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI; 3 Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland; 4 Department of Molecular and Translational Oncology, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland; 5 Retired from University of London, London; 6 Hospital de Clinicas “Jose de San Martin” Buenos Aires University, Buenos Aires, Argentina; 7 Centro Materno Infantil do Norte, Centro Hospitalar Universitario do Porto, Oporto, Portugal; 8 Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; 9 Department of Obstetrics and Gynaecology, Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, Spain; and 10 Department of Gynecology, Clinica de Salud Femenina, Ciudad de Mexico, Mexico Correspondence to: Leonardo Micheletti, MD, Department of Obstetrics and Gynaecology, University of Torino, Torino, Italy, Via Ventimiglia, 3 10126, Torino, Italy. E-mail: l.micheletti@libero.it The authors have declared they have no conflicts of interest. The ISSVD Surgical Oncological Procedure Definitions Committee: Chairman Leonardo Micheletti (Italy); Co-Chairman Hope Haefner (United States); and Members: Allan MacLean (United Kingdom), Claudia Pereira (Portugal), Celeste Sluga (Argentina), Josep M Solé-Sedeno (Spain), Victor Manuel Vargas-Hernandez (Mexico), Kamil Zalewski (Poland), and Facundo Gomez Cherey (Argentina). © 2020, ASCCP DOI: 10.1097/LGT.0000000000000501 ORIGINAL RESEARCH ARTICLE:VULVA AND V AGINA 62 Journal of Lower Genital Tract Disease • Volume 24, Number 1, January 2020 Copyright © 2019 ASCCP. Unauthorized reproduction of this article is prohibited.