Between March 1, 1984, and May 23, 1990, 26 patients underwent laser vaporization for grade 3 vaginal intraepithelial neoplasia. Twenty of these patients had prior hysterectomy, 12 of them because of cervical neoplasia. Ten patients had undergone prior treatment for vaginal intraepithelial neoplasia. Eleven (42%) developed recurrence of vaginal neoplasia with a mean time to recurrence of 22 weeks. Three of the 11 patients had invasive cancer at the time of recurrence. One patient had invasive cancer on biopsy at the time of laser vaporization and subsequently underwent radiation therapy. The remaining 14 patients remain alive with no evidence of recurrent disease at a mean follow-up interval of 117 weeks. In our hands, laser vaporizaiton did not appear to be efficacious treatment for grade 3 vaginal intraepithelial neoplasia, especially when diagnosed in the region of a vaginal cuff scar.