Vulvar cancer is a disease which mainly affects elderly women. The treatment has become less radical over the last years due to the usage of the sentinel node procedure. In this thesis the long term follow-up of patients treated with this procedure is assessed. The results show that the treatment is safe, but the local recurrence rate remains high, with 40% of patients developing a local recurrence within 10 years. Further research was performed to determine the prognostic factors for a local recurrence. The presence of a premalignancy or the skin disease lichen sclerosus in the tumor margin increases the local recurrence rate. Patients with human papillomavirus (HPV) related tumors show a lower local recurrence and higher survival rate compared to patients with a non-HPV related tumor. The tumor microenvironment (tumor surroundings) was analyzed for the fibroblast markers alpha smooth muscle actin (α-SMA) and platelet derived growth factor beta receptor (PDGFβR). Patients with higher intensity of these markers showed a higher local recurrence rate. Lastly this thesis assesses the outcome of the lotus petal flap procedure, a reconstructive surgery technique where part of the vulva is reconstructed. The sexual function of patients undergoing this procedure was decreased due to higher pain levels, however patients are satisfied with their sexual functioning.