The patient's prognosis is most dependent on the tumour size, depth of invasion and the number of metastatic inguinal lymph nodes. The tumour stage (see Table 8.1) and the site of the tumour on the vulva are other prognostic factors. Central tumours (involving the clitoris) have a worse prognosis than lateral (labial) tumours, and are more difficult to treat. The probability of lymph node metastases is closely related to the depth of invasion into the vulval skin, and bilateral metastases are more likely to occur from a central tumour than a lateral one. Patients with Stage I or II disease and negative lymph nodes have a five-year survival of 80-90%. Five-year survival in node-positive tumours is 30-55%, depending on the number of nodes Involved.
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