Re-excision is the best treatment for stage I vulvar squamous cell carcinoma with close or positive surgical margins. Given the relative rarity of stage I vulvar cancer, to date there are no prospective studies that directly evaluate re-excision versus adjuvant radiation for close or positive margins. More recent retrospective studies question if margin status truly predicts recurrence and if any further treatment following primary excision is warranted. Vulvar surveillance is simple with direct visualization, and re-excision is effective for most recurrences. Adjuvant radiation has a host of morbid and often permanent side effects with nearly all patients experiencing some degree of these complications. Further, adjuvant radiation complicates treatment of future recurrences by hampering future healing and eliminating radiation as a future treatment option. Thus, although adjuvant vulvar radiation may have the potential to reduce local recurrence, the associated long-term morbidity risk far outweighs the benefits, and re-excision in the treatment of choice for patients with stage I vulvar squamous cell carcinoma with close or positive surgical margins.