Wide Local Excision versus Simple Vulvectomy in Vulval Intraepithelial Neoplasia 3: Case Report and Literature Review

Abstract

Vulvar intraepithelial neoplasia is a premalignant lesion of the vulva. Women with vulvar cervical intraepithelial neoplasia 3 are at high risk of recurrence and vulvar carcinoma. They warrant a surgical management for the same reason. It may be either ablative or excisional, sometimes can be a combination of both. The decision for wide local excision or simple vulvectomy depends on clinical factors. Case: We present a case of a 67-year-old lady who presented with vulvar itching and a large black vulvar lesion involving the fourchette area, with HPV 16 positive. Initially, there was a doubt of melanoma, but vulval biopsy was suggestive of high-grade squamous intraepithelial lesion (HSIL) (vulval intraepithelial neoplasia 3 [VIN 3]). As it was a single large lesion, the initial plan was wide local excision but as the lesion was large and occupying almost half of the vulva, the decision of simple vulvectomy was taken. A wide local excision would have resulted in vulvar asymmetry and since there was a big lesion, chances of satellite lesions over the vulva were there; decision was made for simple vulvectomy. In this case report, we will review the literature on the surgical management of VIN 3. Conclusion: Treatment is recommended for all vulvar HSIL because of the potential for invasion. Simple vulvectomy is an easy procedure, with less hospital stay, less blood loss, and least recurrence rates. It is a suitable treatment option for multifocal and large lesions of the vulva.