The management of vulvar cancer has changed in the past two decades. Modern treatment of vulvar cancer must be individualized, and less radical surgery is now being performed if possible, in consideration of the quality of life (QOL) of patients. Even though the treatment now tends to be conservative, lymph nodes in all patients should be appropriately treated, with the only exception being microinvasive cancer with less than 1-mm stromal invasion. Here we review the up-to-date management of lymph nodes in patients with vulvar cancer.