Premalignant disease of the vagina is generally detected on cytologic screening. Once an abnormal cytology is obtained, a biopsy directed by colposcopic examination is required to verify the severity of the changes. Because vaginal intraepithelial neoplasia is often multifocal, it is necessary to inspect the entire vaginal canal.
Most lesions occur at the vaginal apex. Audet-Lapointe and colleagues noted that 61 of 66 cases of vaginal intraepithelial neoplasia occurred in the upper third of the vagina. These lesions usually can be excised locally. Other modalities often are preferred, however, because of the multifocal nature of this disease or the necessity of excising large areas, requiring skin grafting.
Nonsurgical approaches for treating these lesions include laser ablation and 5-FU cream for widespread multifocal disease. Carbon dioxide laser frequently has been used and, if carried to a depth of 2 to 4 mm, allows for vaporization of abnormal tissue. Preliminary results reported by Petrilli and colleagues with this modality have shown a success rate of approximately 90%. Radiation currently is not recommended for the treatment of noninvasive disease because of the proximity of the bladder and rectum and the availability of newer modalities.
Another approach to treating vaginal intraepithelial neoplasia is the use of 5% 5-FU cream for approximately 7 days, repeated every 3 to 4 weeks if the vaginal intraepithelial neoplasia persists. Hyperkeratotic lesions appear to be less sensitive to treatment because of their thickness and parakeratosis. Krebs reported on the use of 5% 5-FU daily for 10 days and noted that 17 of 20 patients with vaginal condylomas responded to this therapy. Petrilli and colleagues and Ballon and colleagues reported success rates of 80 to 90% for vaginal intraepithelial neoplasia after multiple cycles of therapy.
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