Surgery or topical therapy for vulval intraepithelial neoplasia

Combination of surgery and laser for the treatment of extensive VIN3 and vulval condyloma: A case report

Introduction and importance

Vulval intraepithelial neoplastic lesions (VINs) are rare lesions that appear with limited signs of pre-malignancy restricted to the vulvar epithelium. One of the principal causes of VINs is the human papillomavirus (HPV) infection, especially in people with weakened immune systems and young women.

Case presentation

A 35-year-old woman presented with VIN3 who had severe immunosuppression and was under corticosteroid treatment. Her lesions were treated with a laser and surgical excision.

Clinical discussion

Pathological findings indicated full thickness dysplasia and HPV infection. Follow-up after 5 years showed complete recovery and no recurrence, with a restoration of the vulva esthetics.

Conclusion

Due to the increasing prevalence of VIN malignancy in young women and the importance of maintaining normal anatomy and function of the genitalia, a combination of surgery and laser can be used instead of extensive surgery only.

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Vulval intraepithelial neoplastic lesions (VIN) are rare lesions that appear with limited signs of malignancy restricted to the epithelium of the vulva.

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Human papillomavirus (HPV) infection is among the principal causes of VIN, especially in immunocompromised individuals.

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The VIN is divided into three degrees (like cervical intraepithelial neoplasia-CIN) as VIN1, VIN2, and Vin3.

Photodynamic therapy for vulvar leukoplakia

The aim of study is to evaluate the tolerability and effectiveness of photodynamic therapy as an organ‑preserving treatment in patients with vulvar leukoplakia. 50 patients with a verifed diagnosis of «vulvar leukoplakia» were included in the study. The age varied from 27 to 74 years. The method of treatment assumed the use of the photosensitizer рhotolon (RUE «Belmedpreparaty», Belarus) administered intravenously in doses of 1.8–2.5 mg/kg. Photoirradiation of pathological foci was carried out 2.5–3 hours after intravenous injection of photolon® using a semiconductor laser «UPL PDT» (LEMT, Belarus, λ=661 nm) at exposure doses from 30 to 100 J/cm2 with a power density of 100–170 mW/cm2. The treatment was performed under medical anesthesia. The results of treatment were evaluated using clinical data. Adverse reactions and complications after the introduction of the photosensitizer and photoirradiation have not been observed. Complete clinical regression of the treated pathological foci was noted in 100% of cases with a follow‑up observation 1 month after the treatment. At follow‑up after 3 months, local recurrences of the disease were detected in 4 cases, which were successfully treated with repeated photo‑dynamic therapy sessions. The percentage of complete regressions was 92%, partial – 8%. The obtained results allow judging on the possibility of using photodynamic therapy in the treatment of patients with vulvar leukoplakia, which allows to preserve the organ and obtain a satisfactory functional and cosmetic result.