Sentinel lymph node (SLN) biopsy is the standard of care for assessing groin nodes in early-stage vulvar cancer, reducing significant morbidity compared to complete inguinofemoral lymph node dissection (IFLD). Adjuvant radiation therapy continues to be an important treatment for those with positive groin nodes. Although patients with a negative SLN can be observed, those with a positive SLN typically undergo a complete IFLD as the next step in management which can introduce increased surgical morbidity and complications. It is tempting to avoid IFLD and give adjuvant radiation therapy instead, raising question whether radiation is a reasonable management plan when there is a positive SLN. However, the data presented here will demonstrate that at present time surgical resection should not be omitted and should remain the standard of care, as radiation therapy alone in positive macrometastatic groin nodes increases risk of groin recurrence which leads to a dismal prognosis.