New guidelines deal with the treatment of pre-invasive lesions of the vulva

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Journal of Lower Genital Tract Disease (2022). DOI: 10.1097/LGT.0000000000000683″ width=”800″ height=”530″/>

vulva high grade squamous intraepithelial lesion; the lesion shows a full-thickness maturation abnormality and acanthosis (hematoxylin and eosin, x10 magnification). Photo credit: Mario Preti et al., Journal of Lower Genital Tract Disease (2022). DOI: 10.1097/LGT.00000000000000683

Four international medical societies have collaborated on consensus statements for physicians published in Journal of Lower Genital Tract Diseaseon the treatment of preinvasive lesions of the vulva.

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

Lesions on a woman’s vulva can cause symptoms such as burning and itching that make 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 the medical literature and voted on by the experts selected from the four scientific societies. The document advises physicians on the four main types of preinvasive lesions that can develop on the vulva.

  1. Vulvar high-grade squamous intraepithelial lesions (VHSIL) are more common in women younger than 65 and can progress to invasive cancer. “Approximately 60% of patients report itching and/or irritation, pain, or bleeding along with visible lesions of the vulva,” explains Dr. Preti and his colleagues. “Others are diagnosed with lesions [by chance] during a routine pelvic exam.” Lesions vary greatly in number, size, shape, color, and thickness from woman to woman. The authors suggest several options for treating VHSIL: surgical removal, ablation (removal with a laser or radiofrequency), or topical medications. If ablation or medications are used, the patient must undergo multiple biopsies beforehand to ensure that no invasive cancer is present present.
  2. Differentiated vulvar intraepithelial neoplasia (dVIN) is much less common than VHSIL because it usually occurs in older women. “Neoplasia” is the growth of abnormal cells or abnormal numbers of cells that may start out benign but become cancerous. dVIN is more likely than VHSIL to turn into invasive cancer—sometimes quickly. According to the new consensus, it should always be completely surgically removed.
  3. Vulvar Paget’s disease in situ is a glandular skin cancer of the vulva that can lead to invasive cancer. Traditionally it was always treated surgically, but today the consensus is that imiquimod skin cream is effective and has minimal side effects. Radiation therapy can be used in some cases.
  4. Vulvar melanoma in situ: Melanoma is the most serious form of skin cancer, but vulvar melanoma in situ is a non-invasive type (stage 1a). The recommended treatment is surgery to remove the lesion and an area of ​​skin around it.

“After treatment of preinvasive lesions of the vulva, women should be evaluated regularly for careful clinical assessment, including biopsy of suspect areas,” advise the authors of the consensus statements. The frequency of follow-up visits depends on the type of lesion, the patient’s age, and whether the patient has an infection, immunological disease, or other lesions in the lower genital tract.

The medical societies that 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.


IBD is not associated with malignancies of the female genital tract


More information:
Mario Preti et al, The European Society of Gynecological Oncology (ESGO), International Society for the Study of Vulvovaginal Disease (ISSVD), European College for the Study of Vulval Disease (ECSVD) and European Federation for Colposcopy (EFC) Consensus statements on pre-invasive vulval lesions, Journal of Lower Genital Tract Disease (2022). DOI: 10.1097/LGT.00000000000000683

Provided by Wolters Kluwer Health

Citation: New Guidelines Cover Treatment of Pre-Invasive Lesions of the Vulva (2022 June 21) Retrieved June 21, 2022 from https://medicalxpress.com/news/2022-06-guidelines-treatment-pre-invasive-lesions- vulva. html

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