Laser ablation of surgical margins after excisional partial vulvectomy for VIN: Effect on recurrence.

Abstract

OBJECTIVE To determine the recurrence rates in patients who underwent different surgical treatments for vulvar intraepithelial neoplasia (VIN) 2 and 3. STUDY DESIGN Data on every patient who underwent surgical treatment for VIN 2 or 3 between January 1994 and December 2002 by a single gynecologic oncologist were retrospectively reviewed. The recurrence rates for 3 different surgical therapies were analyzed using Fischer's exact test. RESULTS Thirty-three patients, who had a median age of 46 years (range, 31-80), were identified. The preoperative biopsy demonstrated VIN 2 or 3 in 9.1% and 90.9% of the patients, respectively. The following primary surgical procedures were employed: 16 patients (48.4%) underwent excisional partial vulvectomy with CO2 laser ablation of the margins, 10 patients (30.3%) had CO2 laser ablation alone, 6 patients (18.2%) had an excisional partial vulvectomy, and 1 patient (3.0%) was. treated with the ultrasonic surgical aspirator. No patient had invasive disease. Recurrent disease was seen in 7 patients (70.0%) treated by laser alone, 3 patients (50.0%) who had an excisional partial vulvectomy and 1 patient (6.25%) who underwent a combined laser and excisional partial vulvectomy (p = 0.0016). CONCLUSION The results of this small study suggest that laser and excisional partial vulvectomy for the treatment of VIN 2 and 3 may be associated with a lower recurrence rate than either modality alone. A larger study will be needed to confirm these results.