Simple vulvectomy gives a 5-year survival rate of essentially 100% but is seldom indicated. Other more limited surgical procedures produce equivalent results and are less deforming. The choice of treatment depends on the extent of the disease.

Vulvar intraepithelial neoplasia (VIN) occupying nonhairy areas can be considered an epithelial disease; however, VIN occupying hairy sites usually involves the pilosebaceous apparatus and requires a greater depth of destruction or excision.[1] Whatever procedure is used, a significant number of patients develop a recurrence with the most common sites being the perianal skin, presacral area, and clitoral hood.[2] The use of topical fluorouracil is not a reliable first choice for treatment.

STANDARD TREATMENT OPTIONS:

1. Wide local excision or laser beam therapy or a combination of both.
2. Skinning vulvectomy with or without grafting.
3. Use of 5% fluorouracil cream (response rate of 50%–60%).[3]

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 vulvar cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Wright VC, Chapman W: Intraepithelial neoplasia of the lower female genital tract: etiology, investigation, and management. Semin Surg Oncol 8 (4): 180-90, 1992 Jul-Aug.
2. Di Saia PJ, Rich WM: Surgical approach to multifocal carcinoma in situ of the vulva. Am J Obstet Gynecol 140 (2): 136-45, 1981.
3. Woodruff JD, Julian C, Puray T, et al.: The contemporary challenge of carcinoma in situ of the vulva. Am J Obstet Gynecol 115 (5): 677-86, 1973.