title: Concordance of gross surgical and final fixed margins in vulvar intraepithelial neoplasia 3 and vulvar cancer.
abstract: OBJECTIVE
  To prospectively evaluate the concordance of initial surgical vulvar margins and final fixed margins and to determine the amount of microscopic pathology of grossly negative margins in women with vulvar intraepithelial neoplasia (VIN) 3 or vulvar carcinoma.
  
  
  METHODS
  Women with VIN 3 or vulvar carcinoma undergoing surgical excision were identified. Prior to excision, acetic acid was used to highlight the lesions, and 2 sutures were placed, 1 at the edge of gross disease and another 1 cm distal from the first. After specimen removal and fixation, the distance between sutures and microscopic involvement of VIN was determined.
  
  
  RESULTS
  Twenty-seven women were enrolled; however, only 19 had final fixed specimens that could be accurately measured. The median fixed distance of the vulvar margin was 0.85 cm (mean, 0.83; SD, 0.19) as compared to the gross, 1-cm margin (p = 0.001). Three subjects (16%) had microscopic involvement by VIN 3 in the grossly negative epithelium between the 2 sutures, but none had a positive peripheral margin.
  
  
  CONCLUSIONS
  The gross surgical margin after vulvar resection is reduced by 15% when measured in its final fixed state, and a grossly negative 1-cm margin will seldom harbor significant disease.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, 800 Rose Street, 331A Whitney-Hendrickson Building, Lexington, KY 40536-0298, USA. cpd12@alltel.net
authors.forename: Christopher P
authors.initials: CP
authors.lastname: DeSimone
authors.forename: Meredith P
authors.initials: MP
authors.lastname: Crisp
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Ueland
authors.forename: Paul D
authors.initials: PD
authors.lastname: DePriest
authors.forename: John R
authors.initials: JR
authors.lastname: van Nagell
authors.forename: Subodh M
authors.initials: SM
authors.lastname: Lele
authors.forename: Susan C
authors.initials: SC
authors.lastname: Modesitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery*