The treatment of VLSIL and early invasive vulvar cancer are now conservative. Total simple vulvectomy has been replaced by partial vulvectomy (wide local excision), laser vaporization, and immune response modifiers (IRMs), Imiquimod. Because VLSIL is found more often in younger patients, even "conservative treatment" can be too aggressive. For example, extensive laser vaporization can cause important pain, excessive healing time and scarring of the tissue. Biopsies are mandatory when VLSIL is suspected to make sure that early invasive cancer present. When it happens, conservative treatments are local excision alone in stage 1a, and in stage 1b, local excision with sentinel nodes mapping are the best choice when the SN are negative.
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