If a patient has a carcinoma of her vulva, she needs a wide and mutilating excision of the primary, with a margin of normal tissue of at least 2 cm all round, and 1 cm deep to the lesion. If her groin glands are involved, she needs a bilateral groin dissection. If you cannot refer her, all you can probably offer her is terminal care.
CARCINOMA OF THE VULVA. THE DIFFERENTIAL DIAGNOSIS includes: vulval warts, syphilis (primary and secondary), donovanosis (granuloma inguinale: like a carcinoma this eats away tissue), and lymphogranuloma venereum, and (very important) the granulations of Schistosoma haematobium, see Section 20.14.
CAUTION ! Before contemplating a radical operation on the vulva, be sure to do a biopsy: it is tragic to do a mutilating operation for an innocent lesion.