Treatment of late-stage cases of vulvar cancer constitutes a significant challenge for any gynecologist oncologist. High local advancement of the tumor, frequent invasion of functionally important organs, e.g. urethra, vagina and rectum, as well as high risk of metastases to regional lymph nodes require a particularly in-depth analysis of prognosis, scope of planned surgery and possible implementation of adjunctive therapeutic modalities. The paper presents our experience in surgical treatment of locally advanced vulvar cancer and a review of current literature concerning these issues. During the last few years, high effectiveness of ultraradical exenteration surgery in persons with locally advanced vulvar cancer, particularly in cases with no metastases to regional lymph nodes, has been confirmed many-fold. Past decade provided a large body of convincing data, indicating high therapeutic effectiveness of less radical procedures, particularly if combined with radiotherapy or radiochemotherapy. Use of neo-adjuvant radiotherapy or radiochemotherapy prior to surgery, yields a high rate of local control with concomitant preservation of sphincter function, thus limiting the indications for ultraradical procedures. In spite of evident progress in the treatment of locally advanced vulvar cancer, cases with invasion of regional lymph nodes still constitute a significant clinical problem. This prognostically unfavorable group of patients urgently requires the development of new systemic therapeutic protocols, including novel chemotherapeutic agents.