Medical associations publish guidelines for the treatment of pre-invasive lesions of the vulva

Four international medical associations collaborated on physician consensus statements, published in the Journal of Lower Genital Tract Disease, on the treatment of pre-invasive lesions of the vulva. The magazine is part of Wolters Kluwer’s Lippincott portfolio.

A pre-invasive vulvar lesion is an area of ​​skin or mucosa that has not yet progressed to invasive malignancy (cancer), but has the potential to do so. “Pre-invasive vulvar lesions deserve specific attention because, in addition to oncological risk, they affect not only functionality and body image, but also psychosexual factors,” said the lead author of the guidelines, Mario Preti, MD of the University of Torino, Italy. , and his co-authors.

Lesions on a woman’s vulva can cause symptoms such as a burning sensation and itching that make sexual intercourse painful, but they can be asymptomatic, the authors note, underscoring the need for proper vulvar examination.

The consensus statements were compiled after a systematic review of medical literature and voted on by experts chosen by the four scientific societies. The document provides advice to doctors about the four main types of pre-invasive lesions that can develop on the vulva.

1) Vulvar high-grade squamous intraepithelial lesions (VHSIL) are more common in women under the age of 65 and can turn into invasive cancer. “About 60% of patients report itching and/or irritation, pain, or bleeding along with visible vulvar lesions,” Dr. Preti and his colleagues. “In others, lesions are diagnosed [by chance] during a routine gynecological examination.” The lesions vary widely from woman to woman in number, size, shape, color, and thickness.

The authors suggest several options for treating VHSIL: surgical removal, ablation (removal with a laser or radiofrequency), or topical medication. If ablation or medication is used, the patient should have several biopsies beforehand to ensure no invasive cancer is present.

2) Differentiated Vulvar Intraepithelial Neoplasia (dVIN) is much rarer than VHSIL, as it is usually seen in older women. “Neoplasia” is the growth of abnormal cells or abnormal numbers of cells, which may start out benign but become cancerous. dVIN is more likely than VHSIL to turn into invasive cancer, sometimes quickly. It should always be removed completely surgically, according to the new consensus.

3) Vulvar Paget . disease on the spot is a glandular skin cancer of the vulva that can give rise to invasive cancer. Traditionally, it was always treated surgically, but the consensus now is that imiquimod skin cream is effective and has minimal side effects. In some cases, radiotherapy may be used.

4) Vulva melanoma on the spotMelanoma is the most serious form of skin cancer, but vulvar melanoma in situ is a non-invasive type (stage Ia). The recommended treatment is surgery to remove the lesion and some of the skin around it.

“After treatment of pre-invasive vulvar lesions, women should be seen regularly for careful clinical assessment, including biopsy of any suspicious area,” advise the authors of the consensus statements. The frequency of follow-up visits depends on the type of lesion, the age of the patient, and whether the patient has an infection, immunologic disease, or other lesions in the lower genital tract.

The medical societies that have published the guidelines are the European Society of Gynecological Oncology, the International Society for the Study of Vulvovaginal Disease, the European College for the Study of Vulval Disease, and the European Federation for Colposcopy.


Reference magazine:

DOI: 10.1097/LGT.0000000000000683

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