Table 3.

Recommendations based on the pitfalls in the assessment of the depth of invasion in vulvar squamous cell carcinoma vulvar squamous cell carcinoma

Pitfalls		Recommendations	Examples, see Figure 2
1.	Recognition which invasive nest is deepest	In tumours ≤1 cm; totally embed the carcinoma If still uncertain, cut at least two deeper levels on the block	A–C
2.	Recognition whether or not there is in fact invasive growth and where it starts	See recommendations of pitfall 1 Tumours >1 cm; enclose one tissue block for every 0.5 cm of the carcinoma	B–F
3.	Curved surface with two or more possible locations of the surface	Measure from the surface resulting in the least favourable depth of invasion	G
4.	Carcinoma situated on the edge of the tissue block	Locate the carcinoma in the middle of the block if possible	H
5.	Ulceration	Sample the carcinoma without ulceration. If not possible, measure from the floor of the tumour ulcer	I
6.	Different measurement methods are used	Use the conventional method. Do not routinely use the alternative method until validated, but if used, state the method of measurement used in the pathology report	J

In case of doubt, if micro‐ or macroinvasive growth (FIGO stages IA or ≥IB) is present in the carcinoma after following the above recommendations, we advise consultation with an expert gynaecopathologist.