Treatment of Vulvar Intraepithelial Neoplasia with the CO2 Laser NINA PALMGREN COLOV, INGRID THRANOV, ARNE BERGET Department of Obstetrics and Gynaecology, Gentofte University Hospital, Hellerup, Denmark Correspondence to Ame Berget, MD, Department of Obstetrics and Gynaecology, Gentofte University Hospital, 2900 Hellerup, Denmark Abstract. From 1982 to 1987, 18 consecutive patients with vulvar intraepithelial neoplasia were treated with CO,) laser vaporization. Prior genital tract malignancy or premalignancy was seen in 72c2 of the patients. The area around the commisura posterior was involved in 94c~ of the cases, and the disease showed multifocal localization in 56c~. Of the patients 56% were disease-free after a single laser treatment; after three treatments 95c~ were disease-free. The mean follow up was 28 months (range 3-66); the recurrences occurred after 6-51 months, and all of them were macroscopically detectable. Colposcopy was important, whereas cytology had no importance in diagnosing the recurrences. There were no cases of progression to invasive carcinoma. The treatment was well tolerated, there were few complications and no perma- nent sequelae. CO2 laser vaporization of vulvar intraepithelial neoplasia represents an improve- ment, as long as the patients are followed up closely and informed that more than one treatment may be necessary. INTRODUCTION During the last decades the incidence of vulvar intraepitheiial neoplasias (VIN) has been in- creasing (1, 2). Previously it was regarded as a disease of middle and old age, but the rise in frequency is reported to be made up primarily of younger women (2, 3, 4, 5, 6). The classical treatment of VIN has been total vulvectomy. The mutilating effect of this treatment and the attendant psychosexual problems, especial- ly with the rising number of younger patients, has led to alternative treatments including wide local excision, skinning vulvectomy with skin graft and topical chemotherapy. The Car- bon Dioxide Laser is a relatively new and prom- ising alternative in the treatment of VIN (2, 5, 6, 7, 8, 9). In this study the results of CO2 laser treat- ment of 18 consecutive patients with VIN is presented. MATERIALS AND METHODS Between 1982 and 1987 18 consecutive, un- selected patients with the diagnosis VIN, were treated with the CO2 laser. In all cases the di- agnosis was based on both macroscopic and col- poscopic abnormalities and confirmed by biop- sies. The histological evaluation was done according to the criteria of The International Society for the Study of Vulvar Disease (10). Laser vaporization and in some cases excision was performed with a Sharplan 720 CO2 laser attached to the operating microscope (colpo- scope). Using a focal distance of 300 mm, spot size 0.6mm and 18W, the power density was approximately 5000W/cm 2. Vaporization and excision was guided by the colposcope, and in- cluded a 2-4 mm free margin around the lesion. The depth of vaporization was 2-3 mm. Follow- up consisted of clinical, macroscopic, colposco- pic and cytologic examinations. Biopsies were taken liberally from suspicious areas. Patients were seen every three months till disease-free, every six months thereafter. RESULTS The age at the time of diagnosis ranged from 31 to 77 years (median 52.5 years). In 67% the diagnosis was carcinoma in situ and in 33% it Paper received 13 September 1989 Lasers in Medical Science Vol 5:61 1990 (~ Ba~71iere Tindall