VULVAR INTRAEPITHELIAL NEOPLASIA-III - OCCULT CANCER AND THE IMPACT OF MARGIN STATUS ON RECURRENCE

Objective: To determine the impact of margin status on disease recurre nce and the incidence of occult cancer in women diagnosed with vulvar intraepithelial neoplasia (VIN) III and treated with surgical excision . Methods: Between 1989 and 1995, 73 women were diagnosed preoperative ly with VIN III by vulvar biopsy and were treated with surgical resect ion. Patients were examined postoperatively, and recurrence was diagno sed when a biopsy of suspicious lesions confirmed VIN III. Results: Th e mean age was 45 years; 81% of the patients were white, and 18% were black. Eighty-two percent of the women had used tobacco, 56% had prior cervical dysplasia, and 37% had prior genital warts. An underlying sq uamous vulvar cancer was found in 22% of patients at initial treatment for VIN III. Fifty-nine women had follow-up of at least 7 months. Of these, 66% (39 of 59) had positive surgical margins, 31% (18 of 59) ha d negative margins and 3% had unknown margins (two of 59). With positi ve margins, 46% (18 of 39) suffered recurrent disease; with negative m argins, only 17% (three of 18) had recurrent disease (P = .03). Multif ocal disease and a history of genital warts also correlated with VIN I II recurrence (P = .03 for both). Conclusion: A significant number of women diagnosed initially with VIN III on a vulvar biopsy harbored occ ult vulvar cancer. Recurrences were almost threefold higher when margi ns were positive for residual VIN III. We conclude that surgical resec tion is an appropriate method of treatment of VIN III for both diagnos tic and therapeutic purposes. (Obstet Gynecol 1998;92:962-6. (C) 1998 by The American College of Obstetricians and Gynecologists.).