Oncology Follow up

Patient Name: Margaret Collins

DIAGNOSIS:
FIGO stage IB HPV-independent p53 abnormal squamous cell carcinoma of the vulva with surrounding differentiated vulvar intraepithelial neoplasia (dVIN), status post vulvectomy and right groin sentinel lymph node biopsy (July 2025), followed by re-resection (simple vulvectomy) on September 7, 2025 for close margin. Final pathology demonstrates complete excision of pre-cancerous tissue (dVIN) with negative margins and no evidence of residual invasive carcinoma.

PREVIOUS RADIATION RECEIVED: 

PREVIOUS CHEMOTHERAPY RECEIVED: 

NARRATIVE: 
Margaret Collins is an 86-year-old female who presented with vulvar squamous cell carcinoma, classified as FIGO stage IB, HPV-independent, p53 abnormal, with associated differentiated vulvar intraepithelial neoplasia (dVIN). She initially underwent a vulvectomy and right groin sentinel lymph node biopsy in July 2025. Pathology at that time showed negative margins for carcinoma and dVIN, but a close invasive margin of 4 mm. As part of the STRIVE/VU2 clinical trial, she was randomized to undergo re-excision of the close margin. On September 7, 2025, she underwent a simple vulvectomy. Intraoperatively, widespread vulvar changes consistent with lichen sclerosus were noted, but no areas were concerning for dVIN or squamous cell carcinoma. Postoperatively, she has recovered well, reporting no concerns regarding wound healing, infection, or other complications. She denies any new symptoms and is aware of her upcoming short-term follow-up with her local gynecologist. She continues to participate in the STRIVE/VU2 clinical trial and understands the need for ongoing surveillance due to the risk of recurrence associated with HPV-independent vulvar cancers.

PHYSICAL EXAM:
Vital signs:  
General:  Well-nourished, well-developed female in no acute distress.  
HEENT:  Normocephalic.  Eyes EOMI, PERRLA.  Sclerae are anicteric.  Oral cavity is clear.  No thrush or mucositis.  
Neck: No adenopathy.  No supraclavicular or axillary adenopathy present.    
Lungs: Clear to auscultation bilaterally.  There are no rales, rhonchi, or wheezing.   
Cardiac:  Regular rate and rhythm with no rubs, murmurs, or gallops.  
Abdomen: Benign, soft, nontender.  Positive bowel sounds.  No masses or organomegaly.  No inguinal adenopathy.   
Extremities: No peripheral edema or adenopathy.   
Neuro: Non-focal.  Alert and oriented x 3.  Gait is normal.  
Musculoskeletal: No point tenderness to percussion or palpation of the spine.   
Skin:  Intact.  No breakdown.  
Psych: Mood and affect are appropriate.  
Remainder of examination is noncontributory.  

LABORATORY STUDIES: 

RADIOLOGY STUDIES: 

PATHOLOGIC STUDIES:
Final pathology from the re-resection (September 2025) demonstrates only differentiated vulvar intraepithelial neoplasia (dVIN), a precursor to cancer, with all margins negative. The closest margin for the pre-cancerous lesion is one millimeter. No invasive carcinoma is identified. The pre-cancerous lesion has been completely resected.

CONSOLIDATED REPORT (Cytology Specimens):

GENOMIC STUDIES:

ASSESSMENT/PLAN: 
Ms. Collins is recovering well postoperatively following re-resection for vulvar squamous cell carcinoma and dVIN. There are no current concerns regarding wound healing or infection. She will continue routine postoperative wound care and follow up with her local gynecologist for wound review in two weeks. Ongoing surveillance with the oncology team is recommended every three to four months, with the possibility of extending intervals if no recurrence is observed. She will continue participation in the STRIVE/VU2 clinical trial. No further surgical intervention is required at this time. She is advised to contact the clinic if any new symptoms or concerns arise.

Today's Orders: 
None at this time.

Medications: 
None currently prescribed.

ICD-10:  
C51.9 - Malignant neoplasm of vulva, unspecified
D07.1 - Carcinoma in situ of vulva

Time spent with patient: 20 minutes
Electronically signed by Dr. Rachel Porter
Rachel Porter, M.D.
Oncology Clinic
2025-09-18