Where the Line Is Drawn: The Prognostic Role of Surgical Margins in Vulvar SCC

AIM: To evaluate the clinical, pathological, and treatment-related factors influencing recurrence and mortality in patients diagnosed with vulvar squamous cell carcinoma (SCC), with a specific focus on the prognostic significance of surgical margin width. METHODS: This retrospective study included 70 patients with histologically confirmed vulvar SCC treated between 2000 and 2020 at a tertiary academic center. Patients were categorized based on tumor-free surgical margin width (< 2 mm, 2-8 mm, > 8 mm). Demographic, clinical, and histopathological parameters were analyzed using Cox regression and Kaplan-Meier methods to assess their impact on disease-free survival (DFS) and overall survival (OS). RESULTS: The median age at diagnosis was 68 years, and 74.3% of cases were FIGO stage I. Median DFS and OS were 46 and 56 months, respectively. Age and tumor grade emerged as independent predictors of mortality and recurrence. Surgical margins < 2 mm were significantly associated with increased recurrence risk (p = 0.001), while no significant effect on OS was observed. Margins ≥ 2 mm conferred a lower recurrence risk, especially in the 2-8 mm group. Lymphovascular space invasion (LVSI) and depth of invasion were significant in univariate analysis but lost significance after adjustment. CONCLUSION: Surgical margin width, particularly margins < 2 mm, is a strong predictor of local recurrence in vulvar SCC. Age and tumor grade are independent predictors of prognosis. These findings highlight the importance of individualized surgical planning and support the development of risk-adapted treatment strategies. Future prospective studies are warranted to refine optimal margin thresholds and improve outcomes, especially in high-risk populations.