Evaluation of CO2 laser excision or vaporization for the treatment of vulvar intraepithelial neoplasia

Objective. Our objective was to evaluate the results of laser surgery in pa tients with vulvar intraepithelial neoplasia (VIN). Methods. From January 1990 to December 1996, 52 patients with histologicall y proven VIN were treated with CO2 laser vaporization or laser excision. Th e analysis included anamnestic characteristics, clinical aspects, types of treatment, correlation of the preoperative biopsy with the excised patholog ic specimen, and follow-up results. Results. Fourteen women underwent laser vaporization, and 38, laser excisio n. Of the patients submitted to vaporization, 11 were cured in one session (75%), 1 required two procedures, and 2 other patients, who underwent more treatments, eventually developed invasive squamous cell cancer 5 and 7 year s from the initial treatment. The cure rate for laser excision was better, as a single session of treatment was curative in 33 of 38 patients (87%). I n 3 cases the pathology report on the excised specimen showed an unrecogniz ed invasive lesion (12%) and the women underwent radical surgery. The 2 rem aining patients, both affected by multifocal disease, experienced recurrenc es and were treated with laser excision 2 and 3 years after the primary tre atment, respectively. Symptom relief was obtained in all patients studied w ith both laser vaporization and excision. Conclusions. Excisional laser surgery is an effective treatment for patient s with VIN. In addition, CO, laser excision allows evaluation of the operat ive specimen and detection of occult early invasion with good preservation of vulvar morphology; laser vaporization, while retaining good cosmetic res ults, is less effective in VIN treatment and does not allow evaluation of t he surgical specimen. (C) 1999 Academic Press.