Management of Vulvar Dysplasia
Dear OncoLink "Ask The Experts,"
Is there a protocol in regard to follow ups after a wide local excision of the vulva? My daughter who is twenty years old was diagnosed with VIN III caused by the HPV virus, and had to have a wide local excision with grafting. Right after the surgery, the doctor told us that she was not able to achieve free margins in certain areas due to the multifocal dysplasia. She said that she was going to laser those sites four months after the surgery. When we went to her office four months later, she did not mention anything in regard to the laser, nor did she perform a vulvoscopy. The exam was done by naked eye. We also could not get a clear answer as to whether she should see a specialist in regard to the anal area since the dysplasia was only about a centimeter from it. I am having second thoughts on our choice of doctor; we do not get our questions answered and we feel there is a sense of apathy on the part of the doctor. Could you tell me what type of follow ups are performed on patients like my daughter?
Stephen C. Rubin, MD, Professor and Chief of the Division of Gynecologic Oncology, University of Pennsylvania Health System, responds:
Vulvar dysplasia is difficult to manage because it is often multifocal, and it may be difficult to determine, even with the use of the colposcope, where the limits of the abnormal tissue are exactly. It is therefore quite common for the margins of an excision to be involved. Patients are typically followed with examinations, sometimes including colposcopy, every four to six months. Often, patients develop recurrences or new areas of dysplasia from time to time, and require additional treatment.
If you are not comfortable with your daughter's current physician, it would certainly be appropriate to see a gynecologic oncologist.