Carcinoma of the vulva involving the perianal or anal skin.

From January 1, 1985, to December 31, 1987, 58 patients underwent radical vulvar surgery for primary squamous cell carcinoma of the vulva. Twenty-four (41%) of the tumors involved the perianal or anal tissues. Nineteen patients had FIGO stage III disease and five patients had stage IV disease. Nineteen of the 24 patients underwent radical excision of their tumors, without colostomy. Two of the 19 excisions included resection of the majority of the anus, and both patients were subsequently left with severe fecal incontinence. In 8 patients the resection involved partial removal of the external and sphincter. Four of these patients developed persistent postoperative fecal incontinence. In the remaining 9 patients the resection involved partial removal of the anal skin, but with the external anal sphincter intact. One of these patients had postoperative fecal incontinence which was unchanged from her preoperative state. In conclusion, carcinoma of the vulva involving perianal tissue can be resected in most cases with adequate preservation of external anal sphincter function. If the sphincter is damaged during the operation, there is a significant risk for subsequent fecal incontinence.