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

Yevgeniya J. Ioffe, Britt K. Erickson, Katelyn E. Foster, David G. Mutch, Matthew A. Powell, Premal H. Thaker, Andrea R. Hagemann, Michael G. Conner, Warner K. Huh, L. Stewart Massad

Research output: Contribution to journalArticle

16 Scopus citations

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 (> 1 mm). 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, χ2 = 31). Deeper tumor invasion of the initial excisional specimen (1-12 mm) was associated with a higher chance of finding carcinoma upon re-excision (range 18-42%, depending on depth of invasion) (p = 0.015, χ2 = 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.

Original languageEnglish
Pages (from-to)528-532
Number of pages5
JournalGynecologic oncology
Volume129
Issue number3
DOIs
StatePublished - Jun 1 2013

Keywords

  • Local recurrence
  • Vulvar cancer
  • Vulvar re-excision

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