Staging of vulval cancer can be done with either the AJCC or FIGO systems, although both are similar.
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Staging
FIGO
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stage I: tumour confined to the vulva
IA: lesions ≤2 cm in size, confined to the vulva or perineum and with stromal invasion ≤1.0 mm*, no nodal metastasis
IB: lesions N2 cm in size or with stromal invasion N1.0 mm*, confined to the vulva or perineum, with negative nodes
stage II: tumour of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with negative nodes
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stage III: tumour of any size with or without extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive inguinal-femoral lymph nodes
IIIA: with 1 lymph node metastasis (≥5 mm), or 1–2 lymph node metastasis(es)
IIIB: with 2 or more lymph node metastases (≥5 mm), or 3 or more lymph node metastases
IIIC: with positive nodes with extracapsular spread
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stage IV: tumour invades other regional (2/3 upper urethra, 2/3 upper vagina), or distant structures
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IVA: tumour invades any of the following:
(i) upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixed to pelvic bone, or
(ii) fixed or ulcerated inguino-femoral lymph nodes
IVB: any distant metastasis including pelvic lymph nodes
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Practical points
vulval melanoma cannot be staged using these systems 2