Significance of positive excision margins in therapy of high-grade vulvar precancerosis – analysis of own data and literary review

Abstract

Objective: In many countries, the incidence of vulvar intraepithelial neoplasia as a precursor of vulvar squamous cell carcinoma has highly increased over the last 3 decades, while the incidence of cancer remained relatively unchanged. Among risk factors for recurrence, resp. progression, usually involve positive excision margins. The aim of the paper is to evaluate the risk of recurrence and progression of high-grade vulvar precancerosis in patients with histological margins “non in sano” – analysis of our own data. Materials and methods: The retrospective study included 62 women after surgical resection of high-grade vulvar precancerosis with histological results of positive excision margins. Using the PubMed database, the results were compared with literary data. Results: Total of 35 (56.5%) patients underwent repeated surgery on the vulva. Inhalf of them (18–51.4%), histological results showed recurrence at the same stage, and in the second half of the women, no dysplastic changes were detected. There was no progression to invasive cancer in any of the patients. Conclusion: Beyond positive excision margins, the other predictive factors seem to be even more important for recurrence or progression of vulvar precancerosis including age, smoking, immunosuppression, radiotherapy, concomitant lesions in the vagina or cervix, and bioactivity of the human papilloma-virus. Instead of repeated resection to reach histological negative margins, we prefer the long-time, resp. long-life dispensarisation.