HealthDay News — In consensus statements published in the July issue of the Journal of Lower Genital Tract Disease, recommendations are presented for the management of patients with preinvasive vulvar lesions.
Mario Preti, MD, from the University of Torino in Italy, and colleagues from the European Society of Gynaecological Oncology, International Society for the Study of Vulvovaginal Disease, European College for the Study of Vulval Disease, and European Federation for Colposcopy developed consensus statements on preinvasive vulvar lesions to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ.
The authors note that an excisional procedure must always be adopted for differentiated vulvar intraepithelial neoplasia, while both excisional procedures and ablative ones can be used for vulvar high-grade squamous intraepithelial lesions (VHSIL). Ablative procedures can be considered for anatomy and function preservation; to exclude malignancy, they should be preceded by several representative biopsies. For VHSIL, medical treatment (imiquimod or cidofovir) can be considered. An approach using imiquimod for vulvar Paget disease is favored in recent studies. Women should be seen on a regular basis for clinical assessment, including biopsy of any suspicious areas after treatment of preinvasive vulvar lesions.
“Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions),” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.