Risk factors for recurrent VIN. Role of multifocality and grade of disease

Abstract

Objective: To evaluate possible risk factors for recurrence of vulvar intraepithelial neoplasia (VIN): menopausal status, smoking, method of treatment (local excision with cold knife, CO2 laser vaporization, CO2 laser excision), grade and focality.

Study design: At the dysplasia clinic of the Department of Obstetrics and Gynecology, Medical Center, Heinrich Heine University, Dusseldorf, Germany, we treated 102 patients with VIN with a mean follow-up of 3.5 years. VIN was demonstrated for all these patients by histologic examination of biopsies taken under colposcopic control. Follow-up was performed by clinical examination and colposcopy. Statistical evaluation was done by the chi 2 test.

Results: VIN recurrence developed in 36.6% of patients. We could not prove any correlation between recurrence of disease and menopausal status, smoking behavior or treatment method used. Recurrent VIN correlated with the grade (P < .001) and focality (P < .05) of the disease.

Conclusion: In the prediction of possible risk of recurrence of disease, not only the grade of VIN but also the multifocality is important. Treatment should be done very carefully considering the functions of the vulva; therefore, mutilating operations ought to be avoided as much as possible.