Open AccessThe European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions
Author(s) -
Mario Preti,
Elmar A. Joura,
Pedro Vieira–Baptista,
Marc van Beurden,
Federica Bevilacqua,
Maaike Bleeker,
Jacob Bornstein,
Xavier Carcopino,
Cyrus Chargari,
Margaret Cruickshank,
Bilal Emre Erzeneoglu,
Niccolò Gallio,
Debra S. Heller,
Vesna Kesić,
Olaf Reich,
Colleen K. Stockdale,
Bilal Esat Temiz,
Linn Woelber,
François Planchamp,
Jana Žodžika,
Denis Querleu,
Murat Gültekin
Publication year - 2022
Publication title -
journal of lower genital tract disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.784
H-Index - 43
eISSN - 1526-0976
pISSN - 1089-2591
DOI - 10.1097/lgt.0000000000000683
Subject(s) - medicine , imiquimod , vulva , vulvar intraepithelial neoplasia , dermatology , colposcopy , disease , biopsy , squamous intraepithelial lesion , intraepithelial neoplasia , malignancy , gynecology , cervical intraepithelial neoplasia , cancer , prostate , cervical cancer
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget's disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. 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).