PDF(Pubmed)
Abstract：
UNASSIGNED: The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget\'s disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).
摘要：
■欧洲妇科肿瘤学会（ESGO），国际外阴阴道病研究学会（ISSVD），欧洲外阴病研究学院（ECSVD），和欧洲阴道镜联合会（EFC）制定了关于侵袭前外阴病变的共识声明，以提高外阴鳞状上皮内瘤变患者的护理质量，外阴Paget病原位,和原位黑色素瘤。对于分化型外阴上皮内瘤变（dVIN），必须始终采用切除程序。对于外阴高级别鳞状上皮内病变（VHSIL），切除手术和消融手术都可以使用。后者可以考虑用于解剖结构和功能保存，并且必须先进行几次代表性的活检以排除恶性肿瘤。VHSIL可以考虑药物治疗（咪喹莫特或西多福韦）。最近的研究支持使用咪喹莫特治疗外阴Paget病的方法。手术必须考虑到疾病的扩展通常比皮肤中明显的扩展更宽。通常认为2厘米的边缘是必要的。对于原位黑色素瘤，建议进行1cm游离手术切缘的广泛局部切除。在治疗侵袭前外阴病变后，应定期对女性进行仔细的临床评估，包括任何可疑区域的活检.应根据复发风险（病变类型，患者年龄和免疫状况，其他相关的下生殖道病变）。
