What should be done for patients diagnosed with high-grade VIN?

For patients diagnosed with high-grade vulvar intraepithelial neoplasia (VIN), the most appropriate approach is a wide local excision. This method is aimed at completely removing the lesions to reduce the risk of progression to invasive cancer. High-grade VIN is considered a precancerous condition, which warrants a more aggressive treatment strategy compared to low-grade lesions.

Wide local excision allows for both diagnosis and treatment, ensuring that any potentially malignant cells are removed. This approach not only addresses the immediate health concern but also alleviates the anxiety surrounding potential progression to vulvar carcinoma. Other treatment options, such as laser therapy, may be applicable in certain cases but are not typically the first line for high-grade VIN, which necessitates ensuring the lesion's complete removal.

Monitoring without treatment is inappropriate for high-grade VIN due to the increased likelihood of progression to cancer. Topical steroids are not effective in treating high-grade VIN lesions and do not offer the necessary intervention required for this serious diagnosis.