Can radical surgical treatment of the vulva be justified in the absence of a conclusive diagnosis of squamous cell carcinoma on biopsy? A retrospective 10-year cohort study.

•Suspicion of vulvar squamous cell carcinoma (VSCC) on pre-operative histopathology is strongly predictive of a final diagnosis of VSCC (p < 0.001).•For cases with strong clinical and pathologic suspicion of VSCC, radical treatment helps avoid second surgeries, at the cost of minimal over-treatment.•Higher patient age, co-morbidity, low clinical suspicion of carcinoma, or proximity of the tumor to the anus often prompt a surgeon to choose local treatment, despite a suspicion of VSCC on biopsy.