# Vulval Intraepithelial Neoplasia: A 15-Year Review of Treatment Outcomes in a UK Centre

## TL;DR

This study reviews 15 years of VIN treatment outcomes in the UK, finding that unifocal VIN with clear-margin excision has the lowest recurrence risk, while multifocal VIN requires close monitoring.

## Contribution

The study provides new insights into VIN recurrence patterns based on treatment modality and disease extent in a long-term cohort.

## Key findings

- Unifocal VIN with clear-margin excision had the longest time to recurrence.
- Multifocal VIN showed high recurrence risk across all treatment types.
- Positive surgical margins were associated with earlier recurrence in unifocal VIN.

## Abstract

Background

Vulvar intraepithelial neoplasia (VIN) is a premalignant condition with a high risk of recurrence. Understanding recurrence patterns may help guide treatment planning and follow-up, particularly when comparing unifocal and multifocal disease.

Methods

We conducted a 15-year retrospective cohort study of patients treated for VIN at Cambridge University Hospitals, a tertiary referral center in Cambridge, England, from 2008 to 2022. Patients received local excision (clear or positive margins), CO₂ laser ablation, or medical therapy (imiquimod/cidofovir) and were stratified into unifocal or multifocal subgroups. Demographic and clinical characteristics were analyzed, with recurrence rates and time to recurrence compared across groups.

Results

A total of 108 patients were included: 26 treated with local excision with clear margins, 44 with excision with positive margins, 25 with laser, and 13 with medical therapy. The median age was 51 years (95% CI 50-55). In unifocal disease, time to recurrence differed significantly by treatment modality (p = 0.04), with the longest median interval in patients with clear-margin excision. In multifocal disease, recurrence risk remained high across all treatment groups without significant differences in time to recurrence (p = 0.21).

Conclusions

Unifocal VIN treated with excision and negative margins was associated with the lowest recurrence risk, supporting the possibility of reduced follow-up intensity in selected cases. By contrast, positive margins and multifocal disease were linked with earlier and more frequent recurrence, underscoring the importance of close, long-term surveillance. These findings may inform follow-up strategies, although further research is needed.