Twenty-nine patients with grade 3 vulvar intraepithelial neoplasia were treated with the carbon dioxide laser while they were under anesthesia. Superficial lesions in nonhairy areas were vaporized to less than 1 mm, but lesions extending onto hairy areas were vaporized to 3 mm to destroy disease in skin appendages. Eighty-three percent of lesions involved nonhairy areas alone. Seventy-two percent of cases were cured by one laser application, 25% by two, and one case by three. Two patients had permanent hair loss after healing. The laser is an appropriate modality for lesions in nonhairy areas but scalpel excision is probably better for vulvar intraepithelial neoplasia in hairy areas.
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