• Biopsy:  follow Cervical Biopsy or Skin Excisional Biopsy, depending on the size of the excision.

• Vulvectomy:
• Determine the type of procedure performed:  hemivulvectomy (unilateral), partial vulvectomy (no deep fascia), total vulvectomy (with deep fascia), radical vulvectomy (with lymph nodes).
• Note which structures are present in the specimen:  labia majora, labia minora, anterior/posterior labial commissures, clitoris, prepuce of clitoris, soft tissue, fascia, lymph node groups.
• Measure the overall specimen (2 surface dimensions + depth) as well as each of the individual structures.
• Describe and measure lesions (color, ulcer, plaque, mass, scar, borders).  Determine which structures are involved by each lesion, measure the distances to the margins, and measure the depth of invasion when you section the specimen.  Describe the uninvolved skin and mucosa.
• Take photographs.
• Ink the resection margins, including those of skin, mucosa, urethra, vagina, soft tissue, and fascia, prior to sectioning.
• If any lymph nodes are present, dissect these in the unfixed state.
• Pin the specimen to a board and allow to “fix” for a few hours before sectioning.

• Biopsy
• If small:  entirely submit the material in tissue processing bags.  Request that tissue be embedded and cut on edge.  Request three H&E levels on each block.
• If large:  submit the entire specimen.  Request that all sections be oriented on edge.
• Vulvectomy
• Tumor or other lesions:  entirely submit, unless very large and obviously invasive, in which case the areas of deepest invasion should be sampled.  Include margins and adjacent uninvolved tissue together with tumor sections whenever possible.
• Margins:  if not already submitted together with tumor sections

• Skin, mucosal, and vaginal margins:  entirely submit (perpendicular is preferable to en face).
• Urethral margin:  en face.
• Soft tissue and fascia margins:  one or two sections closest to tumor; more if multiple areas appear involved.
• Uninvolved structures:  one or two sections of each.
• Lymph nodes:  entirely submit.

Dictation Template 1:  Vulvar Biopsy        

See Cervical Biopsy or Skin Excisional Biopsy, depending on the size of the excision.

Dictation Template 2:  Vulvectomy

Received without fixative/in formalin, labeled _____ and “_____”, is a hemi-/partial/total/radical vulvectomy specimen (__ x __ x __ cm overall), including the left/right labium majus (__ x __ x __ cm), left/right labium minus (__ x __ x __ cm), anterior/posterior labial commissures (__ x __ x __ cm), clitoris (__ x __ x __ cm), prepuce of the clitoris (__ x __ x __ cm), soft tissue and fascia (__ x __ x __ cm together).  There is a _____ (color, ulcerated, verrucous) mass (__ x __ x __ cm) with well-defined/poorly-defined/heaped-up borders involving the _____ (side and structure), located __ cm from the nearest (_____) margin and __ cm from the _____ margin.  It appears to invade the underlying soft tissue for a depth of __ cm and is __ cm from the deep margin.  There is also a _____ (color, plaque, ulcer, verrucous nodule, cyst) on the skin/within the soft tissue involving the _____ (side and structure), located __ cm from the nearest _____ (_____) margin.  The uninvolved skin/mucosa is _____ (color, wrinkled, thickened).  __ (number) _____ (color, consistency) lymph nodes ranging from __ to __ cm are/are not identified in the soft tissue.  Ink code:  left margins = black, right margins = blue.  Representatively submitted as follows:

#__ - #__ = entire mass, including adjacent skin, mucosal, vaginal, and soft tissue margins

#__ - #__ = remainder of skin margins, perpendicular#__ & #__ = remainder of mucosal margins, perpendicular

#__ = urethral margin, en face

#__ & #__ = entire plaque

#__  = clitoris, vertical section

#__  = prepuce of clitoris

#__  = uninvolved left labium majus

#__  = uninvolved right labium majus

#__  = uninvolved left labium minus

#__  = uninvolved right labium minus

#__  = anterior labial commissure

#__  = posterior labial commissure

__ blocks, __ H&E