Treatment of Vulvar Intraepithelial Neoplasia in Vulvar High-Grade Squamous Intraepithelial Lesion
Vulvar high-grade squamous intraepithelial lesion (VHSIL) is a clinically significant precancerous condition of the vulva that requires active management. Selecting the appropriate treatment modality depends on lesion extent, anatomical location, and the need to exclude invasive disease.
Clinical scenario
This protocol addresses the management of vulvar intraepithelial neoplasia presenting as vulvar high-grade squamous intraepithelial lesion (VHSIL). In this setting, both excisional and ablative procedures are recognised treatment approaches.
Treatment approach
Management of VHSIL may involve surgical intervention — encompassing both excisional and ablative techniques — or non-surgical options. Ablative surgical approaches must be preceded by representative biopsies to exclude underlying invasive malignancy before proceeding.
The full protocol — including specific modality selection criteria, sequencing, and all eligible options — is available via the structured regimen below.
References
- For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used.
- Surgical interventions for VHSIL include both surgical excision (from wide local excision to superficial vulvectomy) and ablative therapy (carbon dioxide (CO2) laser vaporization, argon beam coagulation, cavitational ultrasonic surgical aspiration).
- The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy.
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