Carbon Dioxide Laser as Adjuvant Therapy for Human Papillomavirus-Related Squamous Intraepithelial Vulvar Lesions in Chronically Immunosuppressed Women: A Long-Term Real-Life Study

Human papillomavirus-related squamous intraepithelial lesions (HPV-SILs) in immunosuppressed patients pose challenges with multifocality and high recurrence rates. While CO₂ laser therapy is considered effective, our aim was to assess the risk for invasive squamous cell carcinoma (SCC) progression.

Real-life long-term retrospective study on 11 immunosuppressed Latin women with vulvar HPV-SILs that underwent CO₂ laser as adjuvant therapy for extensive and recurrent lesions, assessing the development of high-grade SILs (HSILs) and invasive SCC.

In terms of progression from any HPV-SIL, HSIL was documented in 36% (4/11) at the vulvar region with a 1.7-year median latency, while at the perianal region, it was 45% (5/11) within 5.6 years. Focally invasive SCC developed in only one female (9%) at the perianal region with a 5-year latency and 8.2 years of immunosuppression duration. No metastases were found during the 9-year median follow-up. Anogenital lesions cleared in four patients after a median of three CO₂ laser treatments. Extensive surgery was performed in four patients, but none achieved negative margins.

In this series, vulvar HPV-SILs preceded perianal extension. No invasive SCC developed in the vulvar region. At the perianal region, HSIL progression latency was longer, but the sole case of focally invasive SCC occurred there. Despite low lesion clearance rates, CO₂ laser therapy seems to be a viable option. This study highlights CO₂ laser as a potential adjunctive treatment for vulvar HPV-SILs in immunosuppressed patients, warranting further research and direct comparisons with other treatment modalities as wide surgery excision.