ABSTRACT
Though vulvar cancer incidence ranks only fourth among gynecologic cancers, its precursor lesions occur more commonly and impose a significant burden on the healthcare system.1 The disease incidence is increasing and impacting on younger women,2,3 highlighting the need to refine or replace traditional management. Though treatment for invasive vulvar cancer remains surgical, with few minimally invasive options,4 vulvar intraepithelial neoplasia (VIN) may respond to less aggressive approaches, providing an opportunity to arrest the process in its pre-malignant state. Unfortunately no single treatment, surgical or otherwise, stands clearly superior, and indeed, most treatments have significant shortcomings. Not surprisingly, defining optimal treatment remains elusive.
