Superficial laser vulvectomy. I. The efficacy of extended superficial ablation for refractory and very extensive condylomas.

Sixteen refractory (present for more than 1 year) and 16 very extensive (affecting greater than 60% of the vulva or multiple lesions greater than 1 cm) condylomas were treated by superficial carbon dioxide laser ablation of all papillomavirus-infected epithelium within the lower genital tract. Accurate depth control was maintained by using a special surgical technique to create a plane that limited penetration to the basement membrane. All patients were healed within 3 to 5 weeks, without scarring or significant complications. Of 16 patients with extensive condylomas, 15 were cured by the first laser therapy and the other patient by a second treatment. In contrast, only five of 16 refractory condylomas responded to the first operation, seven to a second procedure and another three to a third treatment. Thirty-one of these 32 patients were finally cured by superficial laser vulvectomy. The other patient required deep dermal destruction and skin grafting. This 97% eventual success rate is encouraging, particularly since there are no other satisfactory alternatives in such difficult cases.