TY - JOUR T1 - 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) consensus statements on pre-invasive vulvar lesions JF - International Journal of Gynecologic Cancer JO - Int J Gynecol Cancer SP - 830 LP - 845 DO - 10.1136/ijgc-2021-003262 VL - 32 IS - 7 AU - Mario Preti AU - Elmar Joura AU - Pedro Vieira-Baptista AU - Marc Van Beurden AU - Federica Bevilacqua AU - Maaike C G Bleeker AU - Jacob Bornstein AU - Xavier Carcopino AU - Cyrus Chargari AU - Margaret E Cruickshank AU - Bilal Emre Erzeneoglu AU - Niccolò Gallio AU - Debra Heller AU - Vesna Kesic AU - Olaf Reich AU - Colleen K Stockdale AU - Bilal Esat Temiz AU - Linn Woelber AU - François Planchamp AU - Jana Zodzika AU - Denis Querleu AU - Murat Gultekin Y1 - 2022/07/01 UR - http://ijgc.bmj.com/content/32/7/830.abstract N2 - 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). ER -