Initial treatment options for biopsy proven high-grade squamous intraepithelial lesions of the vulva

HSIL: high-grade squamous intraepithelial lesion; dVIN: differentiated vulvar intraepithelial neoplasia.
* Simple or skinning vulvectomy is rarely indicated and is reserved for lesions that are extensive or multifocal and highly symptomatic. Referral to a gynecologic oncologist is appropriate.
​¶ CO₂ laser vaporization is the most commonly used ablative therapy. Argon beam and ultrasonic surgical aspiration can also be used.
​Δ Topical therapy with imiquimod can be used for carefully selected patients who are able to tolerate a long treatment course (typically 16 weeks) and would like to avoid ablation. Topical fluorouracil is used only rarely when other treatments have failed.