Smoking and multicentric vulval intraepithelial neoplasia

This study was carried out in order to analyse the multicentric nature and anatomical distribution of vulval intraepithelial neoplasia Grade 3 (VIN3) and to assess the relationship between smoking and VIN3. This is a retrospective study of 80 women with a histologically confirmed diagnosis of VIN3. This study was carried out at a large district general and teaching hospital in North London in a dedicated vulval clinic. A total of 52 (65%) women were smokers and 54 out of the 80 (67.5%) women were diagnosed to have multicentric disease in the form of intraepithelial neoplasia in at least one other lower genital tract site (cervix, vagina or perianal region). Microinvasion at first excision was detected in 20/80 women (25%). Labia minora and fourchette were the commonest sites affected by VIN3. Only 22/80 women were cured with a single treatment, while 58 (72.5%) women needed multiple sessions of treatment. Multiple logistic regression analysis showed that smokers and women who had extensive vulval disease were also likely to have multicentric genital tract neoplasia. Women who continued to smoke after treatment were 30 times more likely to have persistent vulval disease. Women who smoke are statistically more likely to have multicentric genital tract neoplasia and a complete assessment of these cases should include proctoscopy in addition to the colposcopic examination of the cervix and vagina.