"I have had lichen sclerosis for 26 years. Until recently, biopsies never showed atypia. 6 months ago, a biopsy showed atypia and possible early focal VIN. I was treated with Imiqumod for 3-4 months. When there was no visible lesion, I was told to continue using Imiqumod for the mire weeks then stop using it. Although there was no visible lesion, I felt as if something was there. 6 weeks later there were two lesions, significantly worse than the prior lesion. Biopsy results show differentiated high grade VIN2 for both lesions. I was sent to a gynocolic oncologist who is doing a partial bilateral vulvevtomy next weeK
How does the oncologist know that there are clear margins? Is the tissue seen by a pathologist while I am in the OR to see if the doctor got all of the VIN?
Does the fact that I went from possible early focal VIN to differentiated high grade VIN2 despite using Imiqumod put me at increased risk to develop cancer?
I apologize for the delay in responding to your question.
The tissue has to be examined by a pathologist to confirm the diagnosis and the pathologist can tell if margins of biopsy are clear of the lesion or not. It also depends on how close the lesion is to the margin.
However, the decision to operate and how much area to remove depends on the oncologist and surgeon.
I am not an expert on the medicine part so cannot advise on that. Wish you all the best and good health