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Vulvar Intraepithelial Neoplasia: Evaluation of Treatment Modalities

Ribeiro, Filipa MD; Figueiredo, Ana MD; Paula, Tereza MD; Borrego, Jorge MD

Journal of Lower Genital Tract Disease: July 2012 - Volume 16 - Issue 3 - p 313–317
doi: 10.1097/LGT.0b013e3182410544
Review Articles

Objective: The study aimed to evaluate effectiveness and recurrence rate of vulvar intraepithelial neoplasia (VIN) treatment according to treatment modalities as follows: imiquimod (Aldara), laser ablation, laser excision, wide local excision, and skinning vulvectomy. It also aimed to analyze risk factors associated to VIN recurrence.

Materials and Methods: Between January 1997 and December 2010, 29 women were treated and followed up for VIN in our center. Demographics, risk factors, treatment modality, effectiveness, and recurrence data were recorded retrospectively. Study analysis used Student t test and χ2 test.

Results: The median age was 52 years (range = 22–77 years); 52% were smokers, 31% were immunosuppressed, and 34% had concomitant or previous lower genital tract dysplasia. Of all patients, 38% had laser ablation, 31% had laser excision, 24% had wide local excision, and 3% had vulvectomy and imiquimod, with 86.2% overall effectiveness and 20% recurrence (2 laser excision and 2 wide local excision), within a mean of 35 months.

Conclusions: Excisional treatment has diagnostic and treatment advantages in VIN lesions. The goal is to prevent development of invasive vulvar cancer while preserving normal vulvar anatomy and function.

Excisional treatment has diagnostic and treatment advantages in vulvar intraepithelial neoplasia lesions. Margin status seems to be a predictor of recurrent disease.

Maternity Dr. Alfredo da Costa, Lisbon, Portugal

Correspondence to: Filipa Ribeiro, MD, Maternity Dr. Alfredo da Costa, R. João Apolinário 8A-3°B, 2795-207 Linda-a-Velha, Lisbon, Portugal. E-mail: filipacribeiro@gmail.com

©2012The American Society for Colposcopy and Cervical Pathology