PROGNOSIS OF VULVAR DYSPLASIA AND CARCINOMA IN-SITU WITH SPECIAL REFERENCE TO HISTOLOGY AND TYPES OF HUMAN-PAPILLOMAVIRUS (HPV)

Sixty-one women with vulvar dysplasia or carcinoma in situ were treate d with local laser excision of the initial lesion and of the recurrenc es, and followed at intervals of from 3 increasing to 12 months. Recur rences were observed in 16 (26%) patients. No case of invasive carcino ma was seen. Patients with recurrences were significantly younger than those without (p<0.02, median age 42.5 and 54 years, respectively). T he resection borders were significantly more often involved in the ini tial lesions in the group with recurrences (36%) than in the group wit hout (9%) (p<0.014). All lesions were classified according to the WHO (mild, moderate, severe dysplasia or carcinoma in situ) and Toki er al . (1991) (warty, basaloid, combined warty/basaloid or mixed (warty, ba saloid and simple). No pure types of Toki (1991) could be demonstrated . There were no differences regarding recurrences in any of these grou ps. HPV DNA was detected in the initial lesions by PCR in 50/56 (89%) (44 with HPV type 16 and 6 with HPV type 33) and by ISH in 23/61 (38%) . The same type of HPV could be demonstrated in all first recurrences except in two, where HPV type 33 was shown in specimens harboring HPV type 16 in the initial lesions. In one of these cases, HPV type 16 cou ld again be demonstrated in the second and final recurrence. In no spe cimen was more than one type of HPV detected. The results indicate tha t the most important parameter in predicting the recurrence of vulvar dysplasia or carcinoma in situ is the involvement of the resection bor ders. The location of the lesion, the degree and type of dysplasia, an d the type of HPV seem to play a minor role. Local excision and subseq uent intensive control with removal of any visible new lesion probably prevents development of vulvar invasive carcinoma.