Vulval intraepithelial neoplasia is regarded as a precancerous condition of the skin of the vulva that may further develop into vulval cancer. This is usually treated by surgery. The various surgical techniques are either ablative (where the lesion is removed by destruction of tissue using an energy source) or excisional (the lesion is simply 'cut out') and sometimes, may involve a combination of the two. There is currently no consensus on the most effective and safe surgical technique. The treatment options available to the patient are currently based on the preference of the treating physician and their skills and these vary both nationally and internationally. Due to the inherent nature of the disease to present itself repeatedly in spite of multiple treatments, various conservative surgical and medical modalities of treatment are currently being explored.
This review is based on one randomised controlled trial (RCT) of 30 patients and therefore the results are restricted to the analyses of a single study. This RCT compared two ablative techniques, the use of the carbon dioxide laser (CO2 laser) with ultrasonic surgical aspiration (USA). There was no evidence of a difference in the risk of disease recurrence after one year follow-up, pain, presence of scarring, painful/uncomfortable urination (dysuria) or burning, adhesions, infection, abnormal discharge and the presence of dead tissue shedding from healthy skin (eschar) between women who received CO2 laser and those who received USA. Due to the small number of patients with high grade VIN in the trial there was insufficient evidence to conclude that either surgical technique is superior over the other. This review highlights the need for future high quality, well designed trials.