Treatment options for VIN include surgical excision, laser ablation, and topical treatment with imiquimod. The risk of progression from VIN to invasive cancer is 3 to 9 percent ( 3, 4). The incidence of vulvar intraepithelial neoplasia (VIN) is increasing, with 60–75% occurring in young women ( 1, 2, 3). 7 patients (2.3%) recurred with invasive disease a median of 109 months (range 12–327) from initial VIN 2/3 diagnosis. Furthermore, higher rates of recurrence were associated with laser (41.9%) compared with excision (26.4%) or imiquimod (13.6%) (p=0.003). 87 patients (28.7%) developed recurrent disease and it was associated with smoking (p<0.001), larger lesion size (p=0.016), and positive margins (p=0.005). 92 patients (62.6%) were noted to have positive margins, which were associated with larger tumor size (p=0.004). Margin status was available for 147 patients. Smoking history was available for 299 patients, with 40% reporting current tobacco use and 26% reporting previous use. 33% of patients were symptomatic, with pruritus being the most common presenting symptom. The median age at diagnosis was 47 years (range 14–87).
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