Contemporary experience with the management of vulvar intraepithelial neoplasia.

Experience with 40 cases of vulvar intraepithelial neoplasia seen during the 7-year period 1992-98 is detailed. The average age was 46.2 years and 27 of the patients (67.5%) were aged 50 years or younger. There was a significant association with cigarette smoking when compared with age-matched control patients attending the Vulvar Clinic with non-neoplastic conditions (67.5 vs. 12.5%; P = 0.001). Twenty-five percent of the patients had a past history of cervical intraepithelial neoplasia (CIN). The disease was multifocal in 77.5% of patients-92.6% of women aged less than 50 years and 53.8% of older women (P = 0.014). Treatment was by surgical excision supplemented in some cases by laser ablation. Occult stromal invasion was detected histologically in 15% of cases and in half of these, the invasion was to a depth considered to have significant metastatic potential. Recurrence occurred in 50% of patients and was more common in patients with multifocal disease. One patient (2.5%), aged 30, developed invasive vulvar carcinoma 4 years after treatment.