Follow-up, biopsies and results
The mean time of follow-up time was 3.9±0.5 years (range 1-11 years). A total of 30 punch biopsies were performed, in 19 women (15%). In 7 women more than 3 biopsies were performed along the time. Half of the biopsies were performed during the first year of follow-up, mostly during the first visit (suspicious lesion, uncertain clinical diagnosis) or non-response to first line treatment. The remaining were performed whenever a suspicious lesion appeared during the follow-up. We had 3 cases (2.4%) of vulvar HSIL, with two (1.6%) having a subsequent diagnosis of VSCC. No cases of differentiated vulvar intraepithelial neoplasia were observed.
Concerning the 3 cases of HSIL diagnosed, it is relevant to mention that none of those women were smokers, had any type of auto-immune disease or were under systemic immunosuppressive therapy. In case 1, after excisional treatment, the patient was observed at regular 4 months intervals during the first year and then annually; treatment with topical corticosteroid recommend in SOS, with a good compliance to both treatment and follow-up. In case 2, the patient was referred after the diagnosis of VSCC for oncologic treatment consisting of radical vulvectomy with bilateral inguino-femoral lymphadenectomy, and subsequent follow-up every 3 months during the first two years and then every 6 months. In the third case, despite follow-up appointments every 3-4 months, she was diagnosed with VSCC 1,5 years after the diagnosis of HSIL. No evidence of recurrence 5 years after oncologic treatment (surgical treatment plus vulvar radiotherapy).
Table 2 summarizes the data of the cases in which biopsy revealed a pre-malignant/malignant lesion.
Table 2. Data about cases in which the biopsy revealed a pre-malignant/malignant lesion.