It is accepted that lesions with less than 1 mm of invasion may be treated with radical local excision alone (165,172). With more invasive lesions, en bloc resection of the primary tumor and regional groin nodes was traditionally recommended. In the past 15 years, radical vulvectomy was performed less frequently and survival did not seem to be compromised (173). One study reported on 32 patients with vulvar melanoma who underwent local excision (n = 14), simple vulvectomy (n = 7), or radical resection (n = 11) (174). No group had a superior survival rate, although the overall survival rate at 5 years was only 25%. Another study reported on 59 patients who underwent radical vulvectomy and 19 who underwent more conservative resections (163). Survival was not improved by the more radical approach, and they recommended radical local excision for the primary tumor, with groin dissection for tumors with a thickness of more than 1 mm. A recent SEER data analysis of 644 patients with vulvar melanoma did not find a survival difference in patients with localized disease treated with more conservative versus radical surgery. Five-year disease specific survival rates for patients undergoing conservative surgery for localized disease were 75% versus 79% for those undergoing radical surgery (174). Literature on cutaneous melanoma suggests that a 1-cm margin of skin and subcutaneous tissue is sufficient for the treatment of superficial localized melanoma (Breslow tumor thickness <0.76 mm), whereas a 2-cm margin suffices for intermediate-thickness lesions (1 to 4 mm) (175,176). At least a 1-cm tumor-free deep surgical margin is recommended, irrespective of tumor thickness. Because melanomas commonly involve the clitoris and labia minora, the vaginourethral margin of resection is a common site of failure, and care should be taken to obtain an adequate “inner” resection margin (177). A 10-year survival rate of 61% was shown for lateral lesions, compared with 37% for medial lesions (p = 0.027) (149).