Patient counseling will be most important. The patient should be counseled that the treatment will cause a significant change in their body image. All lesions greater than 2 cm or more than 1 mm of invasion will undergo ipsilateral femoral node dissection.

If the lesion involves a structure within 1 cm of a midline structure, then bilateral dissection should be performed.

If ipsilateral nodes are positive, contralateral nodes will be dissected.

Patients with enlarged palpable nodes should have imaging to define the extent of the disease, then if resectable, bilateral removal of large suspicious nodes is advised. Further surgery will be dictated by frozen section. It could include bilateral complete inguinal femoral node dissection or it may be removal of positive nodes and postoperative radiation therapy.

Enlarged pelvic nodes found on imaging may be resected.

There should be a discussion about the high risk of leg edema.

A bowel prep is not routinely performed. However, those patients that will have extensive surgery around the anus or have tissue flaps for reconstruction should take a liquid diet for 24 hours before surgery and an oral cathartic the afternoon before surgery. This will delay bowel movements and decrease the risk of infection.

Antibiotics will begin prophylactically and then redosed after 4 hours of surgery.