Vulvar intraepithelial neoplasia and skin appendage involvement

Article Abstract:

Vulvar intraepithelial neoplasia (Bowen's disease, squamous cell carcinoma) is a class of cancerous skin lesions on the outer region of the vagina (vulva). The cancer is strongly associated with human papillomavirus (HPV) infections. The cancer can affect the hairy and nonhairy regions of the vulva, or invade hair follicles or sebaceous glands. The potential of intraepithelial neoplasia to invade underlying tissues has not been well studied. Many patients will have recurrences after traditional treatments, such as surgical removal of the lesions, removal of the vulva, or chemotherapeutic creams. Laser surgery uses intense heat created by amplified light to manipulate tissues. Although laser surgery is more successful than other therapies in treating the lesions, burning and scarring may be extensive. To help determine the optimal depth of skin that the laser must destroy, the thickness of lesions from 62 cases were studied. The majority of lesions (99.5 percent) measured less than 0.77 millimeters in the hairy region of the vulva and 0.69 millimeters in the nonhairy region. Sebaceous glands were involved in 21 percent of the cases, with the average thickness 0.77 millimeters on hairy skin and 1.07 on nonhairy skin. Most of the lesions extended less than 2.03 millimeters in the hairy region and 1.07 in the nonhairy region. Hair follicles were involved in 32 percent of the cases, with the average depth of the lesion being 1.04 millimeters, and 99.5 percent of the cases were less than 2.55 millimeters. The average thickness of vulvar intraepithelial neoplasia was 0.38 millimeters. It is suggested that in cases where the lesions have not yet invaded into the dermal skin layer, laser treatments should extend to a depth of 1.0 millimeters in the hairy region of the vulva and 2.0 millimeters on the nonhairy region for treatments, to be completely effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Methods, Complications and side effects, Squamous cell carcinoma, Vulvar diseases, Bowen's disease

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Human papillomavirus DNA in CO2 laser-generated plume of smoke and its consequences to the surgeon

Article Abstract:

Genital lesions (warts or abnormal-appearing cells) that contain human papillomavirus (HPV) are often treated with the carbon dioxide laser, which vaporizes the water component of diseased cells. However, other cellular constituents, such as protein and DNA, do not contain water and are carbonized (turned to charcoal) when hit by the laser beam. The smoke plume that results during CO2 (carbon dioxide) laser treatments is evacuated from the area with suction; results from studies of plantar wart removal indicate that HPV DNA may be present in the plume. To determine whether this also occurs when genital lesions are removed, results from laser treatment of 110 patients were evaluated. Samples were taken on swabs from the affected area of the patient and at several points in the plume collecting system. In addition, the nasopharynx, eyelids, and ears of the laser surgeon were swabbed before and after each procedure. The material on the swabs was then examined for the presence of HPV DNA. Results showed that HPV DNA was present in 65 patients. No sample obtained before treatment tested positive; however, one of five pre-filter canisters did test positive for HPV DNA type 6 after exposure to the smoke plume during treatment of the patients. This represents a low rate of dispersion of HPV. Tests of material removed from the surgeon were negative. In summary, the results suggest that the operator who uses a well-functioning CO2 laser to remove genital warts is unlikely to be contaminated with HPV DNA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety and security measures, Measurement, Surgery, Papillomaviruses, Papillomavirus, Condyloma acuminatum, Genital warts, Disease transmission

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Micropapillomatosis labialis appears unrelated to human papillomavirus

Article Abstract:

Human papillomavirus (HPV) can cause infections in the anal and genital tracts of men and women. These infections are common, particularly in women under the age of 35 years. Certain types of HPV are related to the development of epithelial cancers of the male and female anogenital tracts, while other types of HPV appear to be associated with benign disease. One of the most controversial lesions is known as micropapillomatosis labialis. Biopsies of lesions of the vulva or the entrance (introitus) to the vagina were examined using HPV DNA detection techniques. The women with these lesions were followed-up to determine if the viral infections would regress without treatment. Eight of 34 patients with micropapillomatosis labialis had HPV DNA detected, but the differences from the control group were not statistically significant. Eleven patients were treated with either CO2 laser, 5-fluorouracil, or trichloroacetic acid. The lesion persisted in three of these cases. Overall, the spontaneous regression rate was high without treatment, occurring in 45 percent of the women studied. Micropapillomatosis labialis appears to be a common lesion in young women; however, HPV was not identified in a majority of cases. Other DNA detection techniques may be useful for diagnosis and should be used when available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Virus diseases, Vaginal diseases

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