Vulvar wide local excision, simple vulvectomy, and skinning vulvectomy
- C William Helm, MD
C William Helm, MD
- Consultant Gynaecological Oncologist
- Northern Gynaecological Oncology Centre
- Queen Elizabeth Hospital
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 .
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".)
INDICATIONS AND CONTRAINDICATIONS
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')
- 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.
- Chafe W, Richards A, Morgan L, Wilkinson E. Unrecognized invasive carcinoma in vulvar intraepithelial neoplasia (VIN). Gynecol Oncol 1988; 31:154.
- 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.
- ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180.
- 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.
- Abell DA. Simple vulvectomy--a 10-year review. Aust N Z J Obstet Gynaecol 1973; 13:8.
- Di Saia PJ, Rich WM. Surgical approach to multifocal carcinoma in situ of the vulva. Am J Obstet Gynecol 1981; 140:136.
- Rutledge F, Sinclair M. Treatment of intraepithelial carcinoma of the vulva by skin excision and graft. Am J Obstet Gynecol 1968; 102:807.
- Rettenmaier MA, Berman ML, DiSaia PJ. Skinning vulvectomy for the treatment of multifocal vulvar intraepithelial neoplasia. Obstet Gynecol 1987; 69:247.
- 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.
- 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.
- Jones RW, Rowan DM, Stewart AW. Vulvar intraepithelial neoplasia: aspects of the natural history and outcome in 405 women. Obstet Gynecol 2005; 106:1319.
- 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.
- 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.
- Green MS, Naumann RW, Elliot M, et al. Sexual dysfunction following vulvectomy. Gynecol Oncol 2000; 77:73.
- INDICATIONS AND CONTRAINDICATIONS
- SURGICAL ANATOMY
- PREOPERATIVE EVALUATION AND PREPARATION
- Informed consent
- Prophylactic antibiotics
- Other preoperative measures
- OPERATIVE SET-UP
- WIDE LOCAL EXCISION
- SIMPLE VULVECTOMY
- - Vulvectomy
- - Closure
- Postoperative care
- SKINNING VULVECTOMY
- Postoperative care
- Recurrence of VIN after excision
- Effects on sexual function and body image
- SUMMARY AND RECOMMENDATIONS