Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Vulvar wide local excision, simple vulvectomy, and skinning vulvectomy

C William Helm, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Vulvar lesions are a common gynecologic problem. Lesions that are suspicious for malignancy or are premalignant may be excised in a conservative fashion, preserving as much of the vulvar architecture as possible. Treatment approaches also include ablative techniques, (laser, Cavitron ultrasonic surgical aspirator [CUSA]) and pharmacologic therapy [1].

The techniques for vulvar wide local excision and simple or skinning vulvectomy are reviewed here. Diagnosis and treatment of vulvar lesions, precancer, and cancer are discussed separately. (See "Vulvar lesions: Diagnostic evaluation" and "Vulvar intraepithelial neoplasia" and "Squamous cell carcinoma of the vulva: Staging and surgical treatment".)


Conservative excisional procedures are performed for selected benign or premalignant conditions of the vulva, including:

Vulvar intraepithelial neoplasia (VIN) (see "Vulvar intraepithelial neoplasia", section on 'Excision')

Paget disease of the vulva (see "Vulvar cancer: Clinical manifestations, diagnosis, and pathology", section on 'Extramammary Paget disease')


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2017. | This topic last updated: Jan 26, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. von Gruenigen VE, Gibbons HE, Gibbins K, et al. Surgical treatments for vulvar and vaginal dysplasia: a randomized controlled trial. Obstet Gynecol 2007; 109:942.
  2. Chafe W, Richards A, Morgan L, Wilkinson E. Unrecognized invasive carcinoma in vulvar intraepithelial neoplasia (VIN). Gynecol Oncol 1988; 31:154.
  3. Modesitt SC, Waters AB, Walton L, et al. Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence. Obstet Gynecol 1998; 92:962.
  4. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180.
  5. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:381S.
  6. Abell DA. Simple vulvectomy--a 10-year review. Aust N Z J Obstet Gynaecol 1973; 13:8.
  7. Di Saia PJ, Rich WM. Surgical approach to multifocal carcinoma in situ of the vulva. Am J Obstet Gynecol 1981; 140:136.
  8. Rutledge F, Sinclair M. Treatment of intraepithelial carcinoma of the vulva by skin excision and graft. Am J Obstet Gynecol 1968; 102:807.
  9. Rettenmaier MA, Berman ML, DiSaia PJ. Skinning vulvectomy for the treatment of multifocal vulvar intraepithelial neoplasia. Obstet Gynecol 1987; 69:247.
  10. Ayhan A, Tuncer ZS, Doğan L, et al. Skinning vulvectomy for the treatment of vulvar intraepithelial neoplasia 2-3: a study of 21 cases. Eur J Gynaecol Oncol 1998; 19:508.
  11. Caglar H, Delgado G, Hreshchyshyn MM. Partial and total skinning vulvectomy in treatment of carcinoma in situ of the vulva. Obstet Gynecol 1986; 68:504.
  12. Jones RW, Rowan DM, Stewart AW. Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women. Obstet Gynecol 2005; 106:1319.
  13. Fong KL, Jones RW, Rowan DM. Women's perception of the outcome of the surgical management of vulvar intraepithelial neoplasia. J Reprod Med 2008; 53:952.
  14. Likes WM, Stegbauer C, Tillmanns T, Pruett J. Pilot study of sexual function and quality of life after excision for vulvar intraepithelial neoplasia. J Reprod Med 2007; 52:23.
  15. Green MS, Naumann RW, Elliot M, et al. Sexual dysfunction following vulvectomy. Gynecol Oncol 2000; 77:73.