In simple words: This surgery removes part of the external female genital area (vulva) and lymph nodes in one groin to treat vulvar cancer. The surgery aims to remove all of the cancer while preserving as much healthy tissue as possible. The extent of the surgery depends on the size and location of the cancer.

This procedure involves the removal of a portion of the vulva along with the deep subcutaneous tissue and the inguinofemoral lymph nodes on one side. It is performed to treat specific stages of vulvar malignancies. The extent of the resection includes the affected vulvar tissue and the associated lymph nodes in the groin. The clitoris may also be removed if the disease extent necessitates it. The procedure often involves removing deep fascia of the thigh adjacent to the vulva, portions of the lower abdominal area near the vulva, and/or the perineal area below the vulva to ensure clear margins. A Foley catheter is typically placed, and the patient receives general anesthesia. The lymph node dissection usually precedes the vulvectomy. The lymph nodes are identified and removed through an incision in the groin. The vulvectomy is performed with the patient in a lithotomy position. The diseased vulvar tissue is excised, and bleeding is controlled. The resulting defect is closed with sutures or a skin graft, depending on the size of the area removed.

Example 1: A 55-year-old female presents with a 3cm lesion on the left labia majora, diagnosed as squamous cell carcinoma. She undergoes a radical partial vulvectomy, including removal of the left labia majora and minora, along with a left inguinofemoral lymphadenectomy (56631)., A 68-year-old female is diagnosed with vulvar melanoma. The lesion is located on the right side of the vulva and involves the clitoris. The physician performs a partial radical vulvectomy that includes removal of the right portion of the vulva, clitoris, and a right-sided inguinofemoral lymphadenectomy (56631)., A 48-year-old woman with VIN III undergoes a radical partial vulvectomy with unilateral inguinofemoral lymphadenectomy (56631) due to the high risk of invasion. The surgery involves the removal of the affected area of the vulva and the ipsilateral inguinal lymph nodes.

Documentation should include details about the size, location, and characteristics of the vulvar lesion, confirmation of the diagnosis through biopsy, operative report detailing the extent of resection (including which parts of the vulva were removed and which side the inguinofemoral lymphadenectomy was performed), and pathology report confirming the diagnosis and margin status.

** Skin grafting or other reconstructive procedures performed at the same time should be coded separately. If bilateral inguinofemoral lymphadenectomy is performed, use code 56630. The use of sentinel lymph node biopsy may affect coding and should be carefully considered.