Exenteration for Stage IV cancer of the vulva is feasible and desirable, with expected 5-year survival rates of 34–57%. A team of gynecologic oncologists operating simultaneously has the cohesion to reduce operating time, surgical fatigue, and perhaps morbidity and mortality. Data indicate that ultraradical surgery in the 71-year and over age group is nonproductive of salvage and should be individualized critically. Patient selection, attention to detail, and use of the proper surgical procedure are all important in improving results.