Appendix 1. Survey
1. Are you a physician?
☐Yes
☐No
2. In your practice, do you manage patients with vulvar HSIL or differentiated VIN (dVIN)?
☐Yes
☐No
3. What is your medical specialty?
☐Dermatology
☐Genitourinary medicine
☐Gynecology
☐Gynecologic Oncology
☐Family/General Practice
☐Pathology
☐Other (please specify)_____________________________
5. What is your gender?
☐Female
☐Male
☐Other (please specify)_____________________________
6. How many years have you been treating patients with HSIL and dVIN?
☐<5 years
☐6-10 years
☐11-15 years
☐16-20 years
☐>21 years
7. What geographical region do you currently practice in?
☐United States
☐United Kingdom
☐Europe, please specify country _________________
☐Canada
☐Central America
☐Middle East
☐Africa
☐Australia/New Zealand
☐Asia
☐South America
☐Other (please specify)_____________________________
8. Does your pathology department report biopsies using the 2015 vulvar terminology (HSIL, and dVIN) or are they using older terminology?
☐They use the new terminology (HSIL, LSIL and dVIN)
☐They use older terminology (VIN1,2,3 or usual type VIN, dVIN)
☐They use a combination for example: HSIL (VIN3), LSIL (VIN1)
☐It depends, sometimes they use new terminology and sometimes they use older terminology
☐Other (please specify):______
9. Which factors do you consider in your initial treatment of a vulvar HSIL lesion? (choose as many as apply)
☐Size
☐Number of lesions (Unifocal vs multifocal)
☐Location (hair bearing vs non-hair bearing)
☐Location (difficult area to excise for example clitoral)
☐Patient comorbidities
☐Patient Age
☐Quality of underlying and surrounding skin (including presence of other dermatoses)
☐Presence of risk factors leading to HPV infestation (including smoking, cervical disease)
☐Other, please specify
10. In general, what is your first line therapy for the management of unifocal HSIL (usual type VIN) in adult women (non-clitoral lesion)?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Refer to a gynecologic oncologist
☐Other (please specify)________________________________
11. What is your first line therapy for the management of multifocal HSIL (usual type VIN) in adult women (non-clitoral lesion)?
☐Local Excision
☐Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Refer to a gynecologic oncologist
☐Other (please specify)________________________________
12. What is your first line therapy for the management of vulvar HSIL in a hair bearing area?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Refer to a gynecologic oncologist
☐Other (please specify)________________________________
13. What is your first line therapy for the management of clitoral vulvar HSIL?
☐Local Excision
☐Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Refer to a gynecologic oncologist
☐Other (please specify)________________________________
14. For recurrent vulvar HSIL, what is the most common therapy you use?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Refer to a gynecologic oncologist
☐Other (please specify)________________________________
15. Please chose the treatment modalities you use for vulvar HSIL and how frequently you use them?
Almost Always (100- 80%)
Frequentl
y (60-79) Abou t half the time
Occasionall
y (20-40%) Rarel y (0- 20%)
Neve r (0%)
(40- 59%) Local excision
Laser ablation Vulvectomy Photodynamic therapy
Imiquimod Cidofovir 5-fluorouracil Surveillance Other:_____
16. Please provide any additional comments on your treatment of vulvar HSIL.
17.What is your first line therapy for the management of dVIN in adult women?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Other (please specify)________________________________
18.For recurrent dVIN what is your most common treatment choice?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Other (please specify)________________________________
For dVIN with associated Lichen Sclerosis what is your most common treatment choice?
☐Local Excision
☐ Laser Ablation
☐Vulvectomy (partial or complete)
☐Photodynamic Therapy
☐Imiquimod 5%
☐Cidofovir
☐5-fluorouracil
☐Other (please specify)________________________________
19.Please chose the treatment modalities you use for vulvar dVIN and how frequently you use them?
Almost Always (100- 80%)
Frequently (60-79)
About half the time (40- 59%)
Occasionall y (20-40%)
Rarely (0- 20%)
Neve r (0%)
Local excision Laser ablation Vulvectomy Photodynamic therapy
Imiquimod Cidofovir 5-fluorouracil Other:_____
20.Please provide any additional comments on your treatment of dVIN 21.For vulvar HSIL, when do you first see a patient in follow-up after initial treatment?
22.For dVIN, when do you first see a patient in follow-up after initial treatment?
23.How long do you follow-up with your patients, following a successful treatment?
ex. Every 6 months x 2 years then yearly, etc.
24.If you are a specialist do you ever refer patients back to their family doctor/general practitioner/nurse practitioner for follow-up?
☐Yes
☐No
☐I’m not a specialist
☐Other, please specify
25.If you discharge treated HSIL or dVIN back to the primary care provider, do you provide the family doctor/general practitioner/nurse practitioner with instructions regarding how to follow the patient?
☐I’m not a specialist
☐I am a specialist who follows these patients long term
☐Yes I refer back with instructions: (please provide the instructions)
☐I refer back but don’t provide specific instructions
☐Other
26. Please provide any additional comments on how you follow-up patients with HSIL and dVIN
