5-FU/Chemosurgery in the Treatment of Vulvar Intraepithelial Neoplasia

Abstract

ABSTRACT

Ten patients were treated with the experimental technique of 5-fluorouracil (5-FU)/chemosurgery. The technique is microexcision of epidermal neoplasia after application of topical 5-FU. After surgery, maintenance 5-FU is used monthly. All patients had multifocal anogenital neoplasia. Nine patients had in situ carcinoma of the vulva. One had moderate dysplasia. Seven of 10 patients had persistent/recurrent neoplasia following failure of "conventional" therapies. Following chemosurgery, 9 of 10 (90%) patients are in remission for a mean of 47 months. The advantages of 5-FU/chemosurgery include regional suppression of neoplastic tendencies with 5-FU; highlighting of occult neoplasia; predetermination of surgical margins and, thereby, safety; histology is provided; and scarring is minimal. Disadvantages include chemoinflammation, possible residual neoplasia in subepidermal skin appendages. Comparisons are drawn between chemosurgery, laser, and skinning vulvectomy. Chemosurgery is recommended for medial vulvar intraepithelial neoplasia and patients who are immunodeficient or have an anogenital neoplastic syndrome. Chemosurgery is one of the choices of treatment for other patients with lateral vulvar neoplasia.