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Wide local excision vs partial vs radical vulvectomy | CION Cancer Clinics
The types of vulvectomy differ in how much tissue is removed and how deep the cut goes. A wide local excision takes the growth with a rim of skin. A partial vulvectomy takes a larger section, usually one side. A radical vulvectomy takes the growth down to the deep layer, and sometimes the whole vulva. This page explains each one, who it suits, and what your surgeon weighs when choosing. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between the types of vulvectomy?
- Four operations, from smallest to largest
- Wide local excision and radical vulvectomy, compared
- What does the surgeon weigh when choosing?
- Four things families tell us, and what is actually true
- Words you will see, in plain language
- What this page cannot tell you, and what to ask
- Common questions about the types of vulvectomy
The short answer
What is the difference between the types of vulvectomy?
The names describe how much is removed. A wide local excision takes the growth and a rim of skin around it. A partial vulvectomy takes a larger section, often one side. A radical vulvectomy takes the growth down to the deep layer beneath, and sometimes the whole vulva. All three are done under general anaesthetic, and the choice follows the size and depth of the cancer, not the surgeon's preference.
Why the names are confusing
Different hospitals use the words differently, and your consent form may say "radical wide local excision" or "radical partial vulvectomy". The word "radical" means the cut goes down to the deep layer, so that the whole thickness of tissue under the growth comes out. It does not mean the whole vulva is being removed. Ask your surgeon to draw the planned cut on a diagram.
Who none of these is for
Surgery on the vulva is not the usual choice when the cancer has already spread beyond the groin nodes, or when the growth has reached the bladder or the back passage and cannot be removed without damaging them. In those cases radiotherapy with chemotherapy is usually offered instead.
The operations
Four operations, from smallest to largest
Each suits a different situation. The pathology from the biopsy, plus an examination, decides which one is offered.
Wide local excision
The growth and a rim of normal-looking skin around it are removed, leaving the rest of the vulva in place. The wound is usually closed directly.
Usually used for
- Small, early cancers
- Pre-cancer (VIN) that has not cleared with creams
Partial (hemi) vulvectomy
A larger section is removed, most often one side of the vulva, while the other side and usually the clitoris are kept. Groin nodes on the same side are often checked in the same operation.
Usually used for
- A growth confined to one side
- More than one patch on the same side
Radical vulvectomy
The growth is removed with a wide margin and the full depth of tissue beneath it. In a total radical vulvectomy the whole vulva, including the clitoris, is removed. Both groins are usually operated on as well.
Usually used for
- Large or deep cancers
- Cancer that crosses the midline
Skinning vulvectomy
Only the surface layer of skin is removed, leaving the deeper tissue. It is used for widespread pre-cancer, not for an invasive cancer, because the cut does not go deep enough for that.
A skin graft is sometimes needed to cover the area.Side by side
Wide local excision and radical vulvectomy, compared
Wide local excision
Radical vulvectomy
Removes the growth and a rim of skin, to a modest depth
Removes the growth, a wide rim and the full depth of tissue beneath
Groin nodes checked only if the cancer is deep enough to need it
One or both groins almost always operated on
Usually closed directly; home within a day or two
May need a skin flap; usually several days in hospital
Appearance and sensation change little
Appearance changes clearly; sensation may be reduced
Wound problems are less common
Wound breakdown and leg swelling are common enough to plan for
Not sure whether this applies to you?
Ask an oncologistHow the choice is made
What does the surgeon weigh when choosing?
Three things matter most: how deep the cancer goes on the biopsy, how wide it is, and where on the vulva it sits. Depth decides whether the groin nodes need checking. Width and position decide how much skin has to go and whether the wound can be closed without a flap.
Depth is the number that changes the most
A cancer that has grown only a very short distance into the skin has almost no chance of having reached the groin, so the nodes can usually be left alone. Anything deeper than that thin layer is treated as able to spread, and the groin becomes part of the plan. Your biopsy report gives this depth in millimetres; ask which side of the line yours falls.
Position matters as much as size
A small growth close to the clitoris, the urethra or the back passage is harder to remove with a clear margin than a larger one on the outer lip, because the surgeon has less room. This is why two women with cancers of the same size can be offered different operations.
The operation offered can change after the biopsy is reviewed or a scan comes back. That is the plan improving, not the team changing its mind.Commonly believed
Four things families tell us, and what is actually true
"Radical means they are removing everything."
Radical describes the depth of the cut, not the area. A radical partial vulvectomy removes one part of the vulva down to the deep layer and leaves the rest. Only a total radical vulvectomy removes the whole vulva, and that is reserved for large or widespread cancers.
"The bigger operation is always the safer one."
Not for a small cancer. Taking more tissue than the margin needs adds wound problems, leg swelling and loss of sensation without removing any more cancer. The aim is a clear margin, and the smallest operation that reliably gives one.
"A wide local excision is not proper cancer surgery."
It is the standard operation for early vulval cancer in guidelines worldwide. What makes it cancer surgery is the margin of healthy skin around the growth and the pathologist checking that margin, not the size of the wound.
"If they remove the clitoris, that is the end of intimacy."
Sensation and sex do change after a total vulvectomy, and it is right to grieve that. Many women still have a sexual life, in different ways, and it is a fair subject to raise with the surgeon before the operation rather than after.
On your consent form
Words you will see, in plain language
- Margin
- The rim of normal tissue removed around the growth. A clear margin means no cancer cells were found at the edge.
- Depth of invasion
- How far the cancer has grown down into the skin, measured on the biopsy. It decides whether the groin nodes need checking.
- Unilateral or bilateral
- One side or both sides. Used for the groin surgery, and sometimes for which side of the vulva is removed.
- En bloc
- Removing the vulva and the groin nodes in one connected piece. Mostly replaced now by separate cuts, which heal better.
- VIN
- Vulval intraepithelial neoplasia: abnormal cells in the surface layer that are not yet a cancer but can become one.
- Reconstruction
- Moving skin from nearby, or grafting it, to close a wound too wide to stitch directly.
Being straight with you
What this page cannot tell you, and what to ask
This page cannot tell you which operation you should have. That depends on your biopsy, an examination and often a scan, and the decision belongs to you and your treating team. It also cannot tell you how the cancer will behave afterwards; the pathology report after surgery says far more about that than the name of the operation does.
Questions worth asking
Which of the four is planned, and why not the one smaller. How deep the cancer was on the biopsy. Whether the groin nodes will be checked, and how. Whether the clitoris will be kept. Whether a flap or graft is likely. What the area will look like once healed. Having these answers in writing makes the consent form make sense.
If the answer you are given changes after further tests, ask what changed. A good team will be able to point to the exact result.Questions we are asked
Common questions about the types of vulvectomy
Is a partial vulvectomy the same as a hemivulvectomy?
Usually, yes. Hemi means half, and a hemivulvectomy removes one side. Partial is the broader word and can mean any section short of the whole. If your form says one and the surgeon says the other, ask to see the planned cut on a diagram.
Will the clitoris be removed?
Only if the cancer sits on or very close to it. In a wide local excision or a partial vulvectomy on one side it is usually kept. In a total radical vulvectomy it is removed. This is one of the most important questions to ask before the operation.
Can a wide local excision be done for a cancer that has come back?
Sometimes. A small recurrence on the skin, away from earlier scars and radiotherapy, can often be removed the same way. A recurrence in a groin, or after radiotherapy to the area, needs a different plan.
Why do some hospitals still do the older en bloc operation?
Most centres now use separate cuts for the vulva and each groin, because the wounds heal better. An en bloc operation is still occasionally chosen when the cancer has spread through the skin bridge between the vulva and the groin.
Is laser treatment an option instead of surgery?
For some pre-cancer (VIN), laser or a cream can be used instead of cutting. For an invasive cancer, no, because the tissue must be removed and examined to measure depth and margins. Ask your centre what they offer for VIN and what the follow-up would be.
Does a bigger operation mean a longer stay in hospital?
Usually. A wide local excision often means one night. A radical vulvectomy with both groins operated on means several days, because of the drains and the wound. If a flap is used, longer still. Your surgeon can only give a range beforehand.
Will the type of operation change what treatment comes after?
The pathology report decides that, not the name of the operation. If the margin is clear and the nodes are clear, surgery alone is usually enough whichever type was done. If a node contains cancer or the margin is close, radiotherapy is usually advised afterwards.
Are all these operations covered by Aarogyasri or insurance?
Usually yes, as part of an approved cancer treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. The larger operations need pre-approval, which takes a few days. Call the helpline with your card details and we will check your cover.
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Sources
- Cancer Research UK — Surgery for vulval cancer
- American Cancer Society — Surgery for vulvar cancer
- National Cancer Institute — Vulvar Cancer Treatment (PDQ) - Patient Version
- Macmillan Cancer Support — Vulval cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Vulvectomy: What the Operation InvolvesWhat happens on the day, whichever type is plannedHow Much Is Removed and What Is LeftPart by part, what each operation takes and keepsSentinel Node Biopsy for Vulvar CancerThe smaller way of checking the groinReconstruction After Vulvar SurgeryWhen a flap or graft is needed to close the woundDeciding on Cancer SurgeryHow to weigh what the team is recommending
Talk to us
Not sure which operation is being offered?
Send us the biopsy report and the consent form wording, or call the helpline. A surgical oncologist will explain which type it is and why. One helpline serves every CION centre.