Skip to content
My WebMD Sign In, Sign Up

Cancer Health Center

Font Size

Vulvar Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage 0 Vulvar Cancer

Traditionally, there were three grades of vulvar intraepithelial neoplasia (VIN). However, there is little evidence that all three grades are part of the same biologic continuum or that Grade 1 is even a cancer precursor. In 2004, the International Society for the Study of Vulvar Disease changed its terminology, reserving the designation VIN for two categories of lesions based on morphologic appearance:[1]

  1. Usual-type VIN: Human papillomavirus (HPV)-associated Grades 2 and 3 of warty, basaloid, or mixed histology, and usually occurring in young women.
  2. Differentiated-type VIN: non-HPV-associated Grade 3, and usually occurring in older women.

The term VIN 1 was eliminated.[1] Disease that was previously called VIN 1 (grade I) is generally observed without definitive treatment.

Recommended Related to Cancer

General Information About Skin Cancer

There are three main types of skin cancer: Basal cell carcinoma (BCC). Squamous cell carcinoma (SCC). Melanoma. BCC and SCC are the most common forms of skincancer and are collectively referred to as nonmelanoma skin cancers. This summary only covers the treatment of nonmelanoma skin cancers. (Refer to the PDQ summary on Melanoma Treatment for more information.) Incidence and Mortality Nonmelanoma skin cancer is the most commonly occurring cancer in the United...

Read the General Information About Skin Cancer article > >

High-grade VIN is usually managed with active therapy because of a higher risk for progression to invasive disease.[2] Estimates of progression rates are imprecise. A systematic literature review that included 88 untreated patients with VIN 3 reported a 9% progression rate (8 of 88 patients) to invasive vulvar cancer during 12 to 96 months of observation. In the same review, the spontaneous regression rate was 1.2%, all of which occurred in women younger than 35 years.[3] However, in a single-center study, 10 of 63 (16%) untreated women with VIN 2 or VIN 3 progressed to invasive cancer after a mean of 3.9 years.[4]

VIN lesions may be multifocal or confluent and extensive. It is important to perform multiple biopsies in treatment planning to exclude occult invasive disease. VIN located in 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 because it can track along hair roots.

Surgical Interventions

The principal treatment approach is surgical, but there is no consensus on the optimal surgical procedure. The goal is to remove or destroy the entire VIN lesion while preserving vulvar anatomy and function. Simple vulvectomy yields a 5-year survival rate of essentially 100% but is seldom indicated. Other more-limited surgical procedures, including separate excision of multiple lesions, are less deforming.[5] The choice of treatment depends on the extent of the disease and the preference or experience of the treating physician. There are no reliable data comparing the efficacy and safety of the various surgical approaches.

A systematic literature review identified only a single randomized trial comparing any of the surgical approaches.[2] In that trial, 30 women with high-grade VIN were randomly assigned to receive carbon dioxide (CO2) laser ablation versus ultrasound surgical aspiration (USA).[6] There were no statistically significant differences in disease recurrence, painful dysuria or burning, adhesions, or eschar formation between the two treatments after 1 year of follow-up. Scarring was observed in 5 of 16 women treated with laser ablation and 0 of14 women treated with USA (P < .01), but consequences of the scarring on sexual function or quality of life were not reported.[6][Level of evidence 1iiDii] The trial was too small to draw reliable conclusions about the relative efficacy of these surgical techniques. The remainder of the surgical literature is derived from case series and is prone to important study biases.[Level of evidence 3iiiD]

1|2|3

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Next Article:

Today on WebMD

Building a Support System
Blog
cancer fighting foods
SLIDESHOW
 
precancerous lesions slideshow
SLIDESHOW
quit smoking tips
SLIDESHOW
 
Jennifer Goodman Linn self-portrait
Blog
what is your cancer risk
HEALTH CHECK
 
colorectal cancer treatment advances
Video
breast cancer overview slideshow
SLIDESHOW
 
prostate cancer overview
SLIDESHOW
lung cancer overview slideshow
SLIDESHOW
 
ovarian cancer overview slideshow
SLIDESHOW
Actor Michael Douglas
Article