Welcome to your Vulval Cancer

Option List:
A. Vulvectomy
B. Excisional biopsy
C. Punch biopsies of vulva
D. Stage 1b with wide local excision
E. Treat with oestrogen cream
F. Treat with steroids cream
G. Radiotherapy
H. Radical vulvectomy unilateral lymphadenectomy
I. Refer to gynaecology cancer centre.
J. Wide local lesion with ipsilateral groin lymph node removal
K. Radical vulvectomy and bilateral groin lymph adenectomy
L. Stage 1a cancer with wide local excision

1. A 70-year-old is referred to the gynaecology clinic with a history of vulval itching and soreness for the last year, with worsening of symptoms over the last month. On examination, irregular exophytic growth on vulva. Some areas show elevated and irregular surface contour and feel firm and tender to palpate. There is no obvious ulceration. What would be the most appropriate next step?
2.  A 75-year-old has been referred with vulval soreness and a vulval lesion involving the left labia minora. Her past medical history includes hypertension, COPD and atrial fibrillation. The following is the picture:

What is the stage and appropriate management?