RESTRICTED SURGICAL-MANAGEMENT OF VULVAR INTRAEPITHELIAL NEOPLASIA-3 - FOCUS ON EXCLUSION OF INVASION AND ON RELIEF OF SYMPTOMS

A study was undertaken to determine the effectiveness of extensive and restricted surgery for vulvar intraepithelial neoplasia (VIN) 3. All consecutive patients with VIN 3 admitted to a tertiary referral hospit al were included. The main outcome measures were relief and recurrence of symptoms and progression to invasive disease in patients with VIN 3 after extensive or restricted surgery. Of every vulvoscopic visible lesion a biopsy was taken to establish extent and grade of VIN and to rule out invasive carcinoma. Patients with unifocal VIN 3 underwent ex tensive surgery. Patients with multifocal VIN 3 underwent extensive or restricted surgery or an expectant management was adopted, depending on the existence of symptoms and the presence of invasive vulvar carci noma. Forty-seven patients were evaluated. Eighty-three percent of pat ients had a long history of symptoms. Eight patients (17%) had unifoca l VIN 3. In 9% of the patients a superficially invasive vulvar carcino ma was found, ie with a depth of invasion of 1 mm or less. Only 20% of the extensively operated patients had free surgical margins. There wa s recurrence of symptoms in all of the extensively operated patients, in contrast to a 26% persistence or recurrence rate of symptoms in the restrictedly operated patients. In patients with multifocal VIN 3 who underwent restricted surgery, young age of the patient (P = 0.02) and large extension of VIN 3 (P = 0.02) were significant factors in predi cting persistence or recurrence of symptoms. Only once was a superfici ally invasive vulvar carcinoma diagnosed during follow-up, and this wa s in an extensively operated patient. Vulvoscopically directed biopsie s in VIN 3 are a safe method to exclude invasive disease. Restricted s urgery is effective in relieving symptoms in multifocal VIN 3.