Vulvar cancer is a rare and poorly understood disease. While women with cancers confined to the vulva are generally cured with surgery, metastases to the inguinal lymph node basin are the single most important prognostic indicator and portend a markedly worse prognosis. For the women with multiple positive inguinal nodes, the literature is clear that adjuvant radiation will be required to attempt cure. However, there have been conflicting reports regarding whether or not adjuvant radiation improves survival in women with a single positive node. As groin relapse is almost invariably fatal and there is a large SEER analysis showing benefit to radiation for single node positive vulvar cancer, gynecologic oncologists should err on the side of caution and refer all patients with a positive groin node for adjuvant radiation therapy.