ReviewIs the assumed natural history of vulvar intraepithelial neoplasia III based on enough evidence? A systematic review of 3322 published patients
Introduction
The natural history of untreated VIN III is unclear. Untreated patients who hardly ever progress to an invasive vulvar carcinoma have been published [1], [2], [3]. Others have seen progression in nearly all untreated patients [4]. Since data on the follow-up of untreated VIN III are scarce, the natural history of VIN III is mainly based on the follow-up after surgical treatment of VIN III and is considered low [2]. Although extensive surgery, such as vulvectomy, is not the advised standard treatment anymore, removal of all visible lesions to exclude the presence of an occult invasive squamous cell carcinoma is still recommended [5].
The aim of this study was, by means of a systematic review, to assess both the risk of progression of VIN III in untreated patients and the effect of surgical treatment in relation to recurrences and progression of VIN III.
Section snippets
Data identification and extraction
Articles were located in November 2004 using various strategies. Firstly, computer searches of MEDLINE (from 1964), CANCERLIT (from 1980), EMBASE (from 1974), BIOSIS PREVIEWS AB (from 1970) and SCIENCE CITATION INDEX (from 1970) were performed. The following key words were used: vulvar neoplasms in combination with intraepithelial neoplasia, Bowen, bowenoid, Queyrat, carcinoma simplex, early vulvar cancer, hyperplastic dystrophy, condylomatous dysplasia, intraepithelial carcinoma, carcinoma in
Results
A total of 97 articles [1], [2], [3], [4], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83],
Discussion
The dropping age (Fig. 1) coincides with the increased incidence of VIN III between 1975 and 1981 [101]. However, one must realize that both these findings could be due to an increased awareness of this disease.
In this systematic review, the mean age at diagnosis of the invasive vulvar carcinoma was 52 years, while the mean age at diagnosis of VIN III was 46 years. The young age of the patients with invasive vulvar cancer in this study gives support to the idea that there are two different
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