CPT® Code 56631

The procedure described by CPT® Code 56631 refers to a radical partial vulvectomy combined with unilateral inguinofemoral lymphadenectomy. The vulva encompasses various structures of the external female genitalia, including the mons pubis, labia majora and minora, clitoris, vaginal vestibule, urethral opening, and vaginal opening. A radical vulvectomy is a surgical intervention primarily indicated for the treatment of invasive carcinoma affecting the vulva. This procedure is distinct from a simple vulvectomy, as it involves a more extensive excision that penetrates into the perineal fascia. In cases where malignancy is localized to a specific area of the vulva, only the affected portion is excised, as seen in codes 56630 and 56632. The surgical approach is tailored based on the disease's location and extent, ensuring that excision margins are adequately marked to include healthy tissue surrounding the malignancy. The surgical technique involves making an incision through the skin down to the subcutaneous fat, followed by deep dissection that may extend to the perineal fascia and potentially into the periosteum of the pubic symphysis, depending on the tumor's involvement. The excised tissue may include various structures based on the specific area affected, such as the labia, vaginal vestibule, and associated glands. The procedure may also involve unilateral or bilateral inguinofemoral lymphadenectomy, which is performed to remove lymph nodes that may harbor cancer cells, typically on the side of the malignancy. If the cancer is centrally located, a bilateral lymphadenectomy is warranted. The lymphadenectomy is generally performed prior to the vulvectomy, with a careful incision made to access and remove the inguinofemoral lymph nodes.