title: Wide local excision in the treatment of vulvar carcinoma in situ: a reappraisal.
abstract: A retrospective study of 56 patients treated for carcinoma in situ of the vulva over a 24-year period has shown a relative increase in the occurrence of this neoplasm. Only 6.7% of patients in the first 14 years of the study period were less than 35 years of age, as compared with 29.3% in the last decade. In the earlier years of the study, simple vulvectomy was the primary treatment, and 81.3% of the patients were disease-free at 5 years. Wide local excision, used in the later years, resulted in a rate of 46.2% with no evidence of disease. Involvement of surgical margins played a significant role in this increased incidence of recurrence. Only one patient, originally treated by simple vulvectomy, later developed early stromal invasion. A wide local excision technique should be strongly considered as initial management of this multifocal neoplasm. Close follow-up is mandatory. Recurrence of disease may be treated with appropriate wide excision.
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D014846:Vulvar Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D005472:Fluorouracil