Would you use radiation to treat a persistent VIN III lesion that involves the urethral meatus and has recurred multiple times despite ablation and resection?

I recommend more extensive vulvar excision with a possible skin flap because:

1. VIN is not cancer yet. Thus, radiation may not be as effective in VIN cells that are not rapidly dividing.
2. Radiation may cause skin changes which make it more difficult to identify VIN recurrence. I am not sure what the e...

HDR brachytherapy for the entire vagina with a vaginal wall /thickness dose of 6 Gy x 6 is our approach.

Sometimes, if there is a visible lesion like this, then after 5 fractions, limit the last fraction to the visible area with a multichannel cylinder.

I think that the "standard" answer would be to wait until the invasion is documented. Having said that, I would seriously consider a Cs-131 interstitial implant to the area, delivering a dose to total decay of 55 Gy. I have not done exactly this, but I have implanted VIN III adjacent to a positive r...

Am I missing something about why imiquimod wouldn't be preferable to radiation or surgery at this time?