Ultrasound examination is an accurate method in the preoperative evaluation of the inguinofemoral lymph nodes when performed by experienced operators. The purpose of the study was to build a robust, multi-modular model based on machine learning to discriminate between metastatic and non-metastatic inguinal lymph nodes in patients with vulvar cancer. One hundred and twenty-seven women were selected at our center from March 2017 to April 2020, and 237 inguinal regions were analyzed (75 were metastatic and 162 were non-metastatic at histology). Ultrasound was performed before surgery by experienced examiners. Ultrasound features were defined according to previous studies and collected prospectively. Fourteen informative features were used to train and test the machine to obtain a diagnostic model (Morphonode Predictive Model). The following data classifiers were integrated: (I) random forest classifiers (RCF), (II) regression binomial model (RBM), (III) decisional tree (DT), and (IV) similarity profiling (SP). RFC predicted metastatic/non-metastatic lymph nodes with an accuracy of 93.3% and a negative predictive value of 97.1%. DT identified four specific signatures correlated with the risk of metastases and the point risk of each signature was 100%, 81%, 16% and 4%, respectively. The Morphonode Predictive Model could be easily integrated into the clinical routine for preoperative stratification of vulvar cancer patients.

Background: Vulvar stenosis is a debilitating condition that compromises sexual function, urination, and the ability to undergo gynecological examinations. The purpose of this study is to describe the technique of capillary perforator perineal flaps (CPPF) for the correction of vulvar stenosis. Methods: We retrospectively examined patients with vulvar stenosis treated through surgical separation and reconstruction with CPPF. The procedure involved vulvar separation with the creation of a subsequent defect, repaired using a flap, harvested laterally to the labia majora including a capillary perforator and transferred through a subcutaneous tunnel to repair the vulvar defect. The functional outcome was evaluated with the Bradford scale, comparing the preoperative and postoperative scores using the Student’s t-test. Results: thirteen patients were included, three with stenosis following treatment for vulvar cancer and ten due to lichen sclerosus. In total, we analyzed 29 flaps, with an average size of 15.6 cm². We always included just one perforator in the flap and no postoperative complications. Stenosis was resolved in all patients, with no recurrences one year after the surgery. The preoperative average severity of the stenosis was 2.3 + 0.6, reducing to 0.3 + 0.4 post-intervention, indicating a significant improvement (p < 0.01). Conclusions: CPPF has proven to be a quick and safe method for the reconstruction of vulvar stenosis.

Background/Objectives: Pigmented lesions of the genital area are of commonly occurrence, with population-based incidence estimated around 10–20%. Historically, invasive biopsy or surgical removal were recommended to obtain a definite diagnosis. Line-field confocal optical coherence tomography (LC-OCT) is a novel multimodality imaging tool, able to reproduce a “virtual biopsy” of skin lesions, offering vertical, horizontal, and three-dimensional (3D) imaging down to the mid-dermis with high-resolution real-time visualization. The aims of the study were (i) to describe the LC-OCT features in a series of benign and malignant pigmented genital lesions (PGLs), (ii) to investigate the impact of LC-OCT on the diagnostic accuracy, (iii) and to estimate the diagnostic concordance between LC-OCT and histopathology. Methods: This was a retrospective, cross-sectional study including histologically confirmed PGL investigated with LC-OCT over 2 years. Descriptive statistics were calculated for continuous and categorical variables. Diagnostic accuracy of LC-OCT and dermoscopy was compared, and the LC-OCT–histopathology diagnostic concordance was estimated. Results: A total of 96 PGLs were analyzed in 23 male and 57 female patients. Pathologic reporting consisted of 56 melanoses, 21 nevi (15 compound nevi and 6 atypical genital nevi), 10 melanomas, and 9 angiokeratomas. LC-OCT obtained higher diagnostic accuracy rather than dermoscopy; diagnostic concordance LC-OCT/histopathology was 91% (87/96; 95% CI 83.7–95.3). Melanoses were characterized by a continuous undulated junction. Common genital nevi were identified by the presence of regular dense nests, while dischoesive nests were seen in atypical genital nevi. Features of epidermal disarray with pagetoid cells, junctional atypia, and discohesive nests were observed in melanoma. Angiokeratomas showed the presence of dark vascular lacunae. Conclusions: Providing in vivo key clues with a resolution close to classic histopathology, LC-OCT may have a valuable role in the clinical management of PGLs, particularly when lesions involve large areas or are multiple in number.

This retrospective study and systematic review of the literature aimed to investigate the oncologic outcomes of sentinel node biopsy (SNB) procedure in patients with invasive Vulvar Paget's Disease (iVPD). Patients with iVPD who underwent a preoperative lymphatic mapping with [^99mTc]Tc-nanocolloid, followed by SNB between January 2015 and July 2024 were analyzed. A comprehensive search of PubMed/MEDLINE and Scopus was conducted. Original articles evaluating SNB in iVPD patients were eligible. A total of 27 patients were included, 16 (59.3%) had a depth of stromal invasion ≤1 mm (microinvasive disease). SNs were identified preoperatively in 26 available cases (41/44 groins, 93.2%) and intra-operatively in 26/27 cases (44/45 groins, 97.8%). Four groins (8.9%) had metastatic SNs, two with micrometastases and two with macrometastases. Among 16 patients with microinvasive VPD, 2 (12.5%) had metastastic SNs. No groin recurrences were observed in the whole population after a median follow-up of 36 months (95% CI: 27-49 months). The 5-years disease-free survival and overall survival were 74.3% and 83.7%, respectively. A total of 12 studies (100 iVPD patients) were included after systematic review of the literature. Metastatic SNs were reported in 22 patients (22.0%). Among 9 patients with microinvasive disease, 3 (33.3%) had metastatic SNs. Among the 23 patients with available follow-up data, one case of locoregional lymph-node recurrence occurred. Our data, together with evidence from the literature, suggest that SNB technique may be an acceptable approach for nodal staging in iVPD patients, opening the way for an expansion of SN indications in vulvar neoplasms. Microinvasive VPD is associated with a significant rate of metastatic SNs, thus inguino-femoral surgical staging is recommended in this clinical setting.