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

• Published in: Gynecologic oncology 2013-06, Vol.129 (3), p.528-532
• Main Authors: Ioffe, Yevgeniya J, Erickson, Britt K, Foster, Katelyn E, Mutch, David G, Powell, Matthew A, Thaker, Premal H, Hagemann, Andrea R, Conner, Michael G, Huh, Warner K, Massad, L. Stewart
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Hematology, Oncology and Palliative Medicine; Humans; Local recurrence; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Neoplasm, Residual; Obstetrics and Gynecology; Reoperation; Vulva - pathology; Vulvar cancer; Vulvar Diseases - pathology; Vulvar Neoplasms - pathology; Vulvar Neoplasms - surgery; Vulvar re-excision; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2013.02.033

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.