VULVAR INTRAEPITHELIAL NEOPLASIA - LONG-TERM FOLLOW-UP OF TREATED ANDUNTREATED WOMEN

Objective To investigate the long term outcome of patients with vulvar intraepithelial neoplasia. Design A retrospective study using informa tion obtained from patient casenotes. Sample One hundred and thirty-th ree women with a primary diagnosis of vulvar intraepithelial neoplasia (VIN), identified during a 15-year period. Results The diagnosis of v ulvar intraepithelial neoplasia increased throughout the study period. Human papilloma virus changes were noted in 104 patients (78%); these women were significantly younger than those without (P less than or e qual to 0.001). Nineteen (14%) were managed by observation or medical treatment and the remainder by surgical methods. Histological or sympt omatic recurrence after surgical treatment occurred in 55 (48%). When disease recurred, it usually did so within four years of treatment. Re currence was more common following laser vapourisation than after loca l excision (75% vs 40%; P less than or equal to 0.01). Progression to invasive disease occurred in nine patients (7%), none of whom were in the group being observed. Four deaths occurred in this group, three fr om gynaecological malignancies of the lower genital tract. Conclusions Patients with vulvar intraepithelial neoplasia require long term foll ow up, and the risk of invasion may be higher than previously thought. Surgical treatment when required should be by excisional rather than ablative methods in most instances. In selected cases it is also possi ble to safely manage patients by more conservative methods.