Surgery. Vulva cancer
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Because the biologic potential of VIN or carcinoma in situ remains uncertain, conservative therapeutic measures are appropriate. Previously, complete excision of the area at risk was recommended regardless of the size of the lesion. It is now recognized that these lesions are only part of the spectrum of neoplasias that occur over the entire anogenital epithelium. Removal of the entire area at risk may not be feasible and would certainly be disfiguring. Rather than a routine total vulvectomy, wide excision of the intraepithelial neoplasia is more appropriate, particularly for unifocal lesions. Shallow skinning procedures, which remove the full thickness of epithelium of the labia majora and minora, especially over the clitoris, but leave the underlying connective tissues intact, may be used for widespread multifocal involvement. Grossly, a margin of 1-1.5 cm beyond the limits of the lesion should be removed. Primary closure may be accomplished by using rotational flaps or skin grafting. Human growth hormone online
Laser therapy for ablation of an intraepithelial lesion of vulva may be appropriate in selected cases. One of its major limitations is the loss of tissue for histologic interpretation to detect occult invasion. Laser vaporization to a depth of 1 mm including the zone of dermal necrosis should be sufficient to eradicate most epidermal lesions without skin appendage involvement. If the initial biopsy reveals involvement of adjacent hair follicles, deeper tissue destruction is necessary to achieve greater than 90% elimination of the disease. In patients treated by laser therapy, cosmetic results are excellent. Laser vaporization appears to be an effective and nonmutilating therapy and preferable for young patients with VIN. Occult VIN may be present in the adjacent epithelium. Primary lesions may remain undetected by either gross or colposcopic visualization. Therefore, laser ablation has a significant failure rate because of the incomplete ablation, but this rate may be reduced to levels comparable with that of surgical excision if careful attention is given to adequate ablation, clear margins, and histologic studies of suspicious thick lesions.