title: Low yield of residual vulvar carcinoma and dysplasia upon re-excision for close or positive margins.
abstract: OBJECTIVE
  The objectives of this study are to determine the utility of re-excision after a primary diagnosis of vulvar carcinoma by assessing the frequency of residual carcinoma found upon re-excision and to quantitate the wound breakdown and carcinoma recurrence rates.
  
  
  METHODS
  We reviewed 1122 cases of VIN or vulvar carcinoma. Women who underwent re-excisional procedures, as part of their initial surgical treatment were identified. Associations between the margin status of the original excisional sample and histology of re-excision, as well as association between the depth of invasion upon initial excision and histology of re-excision were analyzed with Chi-square tests.
  
  
  RESULTS
  We identified 84 evaluable patients, 72 with stage I disease, 4 with stage II, and 7 with stage III disease. Upon the initial excisional procedure, 33 patients (39%) had carcinoma-positive margins, 27 patients had VIN-positive margins (32%) and 24 patients (28%) had negative margins (>1mm). Upon re-excision, 1/24 (4%) patients with negative margins, 2/27 (7%) patients with VIN-positive margins, and 11/33 (33%) patients with carcinoma-positive margins were found to have carcinoma in the re-excision specimens (p<0.0001, χ(2)=31). Deeper tumor invasion of the initial excisional specimen (1-12mm) was associated with a higher chance of finding carcinoma upon re-excision (range 18-42%, depending on depth of invasion) (p=0.015, χ(2)=19). Nineteen patients (23%) had vulvar wound breakdown post re-excision. Twelve patients (15%) experienced recurrences.
  
  
  CONCLUSIONS
  The yield of micro- or invasive carcinoma at re-excision is low, with a high wound breakdown rate. Re-excision should be considered for patients with margins positive for carcinoma, especially for women with deep invasion, while women with VIN or close but clear margins may be followed.
authors.affiliation: Washington University in St Louis School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, 660 S. Euclid Ave, St Louis, MO 63110, USA. ioffey@wudosis.wustl.edu
authors.forename: Yevgeniya J
authors.initials: YJ
authors.lastname: Ioffe
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.forename: Katelyn E
authors.initials: KE
authors.lastname: Foster
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Powell
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Hagemann
authors.forename: Michael G
authors.initials: MG
authors.lastname: Conner
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: L Stewart
authors.initials: LS
authors.lastname: Massad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012086:Reoperation; D014844:Vulva / Q000473:pathology; D014845:Vulvar Diseases / Q000473:pathology; D014846:Vulvar Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult