[Therapy of preinvasive vulvar neoplasia--standardized or individual?]. / Therapie bei präinvasiver Vulvaneoplasie--standardisiert oder individuell?

The mostly diagnosed preinvasive vulvar neoplasia is of squamous origin called "vulvar intraepithelial neoplasia" (VIN). The knowledge about the biological character of these lesions especially grade 3 is limited. Progression to invasive cancer is expected in > 40 % of untreated patients who are mostly immunocompromised or elderly. After surgical treatment of VIN the risk of invasive cancer is about 4 %. There are no significant differences in later progression and relapse rates between different surgical approaches. Risk factors for relapse are: younger age, positive margins, grade 3, multicentricity, associated intraepithelial neoplasias of the vagina and uterine cervix and immunosuppression. The aim of treatment is the removal of all lesions with negative margins. Individually adapted surgical excision is mandatory to conserve the function and figure of the vulva. Standard surgical procedures are wide local excision or laser vaporisation after safe histological characterisation.