Vulvar intraepithelial neoplasia: evaluation of treatment modalities

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.

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.

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.

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.