Low yield of residual vulvar carcinoma and dysplasia upon re-excision for close or positive margins.

Academic Article

Abstract

  • OBJECTIVES: The objectives of this study are to determine the utility of re-excision after a primary diagnosis of vulvar carcinoma by assessing the frequency of residual carcinoma found upon re-excision and to quantitate the wound breakdown and carcinoma recurrence rates. METHODS: We reviewed 1122 cases of VIN or vulvar carcinoma. Women who underwent re-excisional procedures, as part of their initial surgical treatment were identified. Associations between the margin status of the original excisional sample and histology of re-excision, as well as association between the depth of invasion upon initial excision and histology of re-excision were analyzed with Chi-square tests. RESULTS: We identified 84 evaluable patients, 72 with stage I disease, 4 with stage II, and 7 with stage III disease. Upon the initial excisional procedure, 33 patients (39%) had carcinoma-positive margins, 27 patients had VIN-positive margins (32%) and 24 patients (28%) had negative margins (>1mm). Upon re-excision, 1/24 (4%) patients with negative margins, 2/27 (7%) patients with VIN-positive margins, and 11/33 (33%) patients with carcinoma-positive margins were found to have carcinoma in the re-excision specimens (p<0.0001, χ(2)=31). Deeper tumor invasion of the initial excisional specimen (1-12mm) was associated with a higher chance of finding carcinoma upon re-excision (range 18-42%, depending on depth of invasion) (p=0.015, χ(2)=19). Nineteen patients (23%) had vulvar wound breakdown post re-excision. Twelve patients (15%) experienced recurrences. CONCLUSIONS: The yield of micro- or invasive carcinoma at re-excision is low, with a high wound breakdown rate. Re-excision should be considered for patients with margins positive for carcinoma, especially for women with deep invasion, while women with VIN or close but clear margins may be followed.
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    Keywords

  • Adult, Aged, Aged, 80 and over, Female, Humans, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Neoplasm, Residual, Reoperation, Vulva, Vulvar Diseases, Vulvar Neoplasms, Young Adult
  • Digital Object Identifier (doi)

    Authorlist

  • Ioffe YJ; Erickson BK; Foster KE; Mutch DG; Powell MA; Thaker PH; Hagemann AR; Conner MG; Huh WK; Massad LS
  • Start Page

  • 528
  • End Page

  • 532
  • Volume

  • 129
  • Issue

  • 3