Vulvar intraepithelial neoplasia: Classification, epidemiology, diagnosis, and management

J Gynecol Obstet Hum Reprod. 2020 Nov;49(9):101801. doi: 10.1016/j.jogoh.2020.101801. Epub 2020 May 14.

Abstract

Vulvar intraepithelial neoplasia (VIN) is classified into two entities: differentiated (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL). dVIN is a premalignant lesion that develops on an existing vulvar lesion such as lichen sclerosus, while vH-SIL is associated with HPV infection. The two entities differ in terms of pathophysiology, background, prognosis, and management. The incidence of VIN in young women is rising and recurrence is common, even after radical surgery, which can cause significant disfigurement. Alternative strategies include topical treatments, ablation, and a watch-and-wait approach. There is currently no consensus on how these lesions should be managed. We review the literature in this field.

Keywords: Colposcopy; Differentiated vulvar intraepithelial lesion (dVIN); Human papilloma virus (HPV); Therapy; Vulvar high-grade squamous intraepithelial lesion (vHSIL); Vulvar intraepithelial neoplasia.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Carcinoma in Situ / diagnosis
  • Carcinoma in Situ / epidemiology*
  • Carcinoma in Situ / therapy*
  • Female
  • Humans
  • Lichen Planus / epidemiology
  • Lichen Sclerosus et Atrophicus / epidemiology
  • Middle Aged
  • Papillomavirus Infections
  • Risk Factors
  • Vulvar Diseases / pathology
  • Vulvar Diseases / virology
  • Vulvar Neoplasms / diagnosis
  • Vulvar Neoplasms / epidemiology*
  • Vulvar Neoplasms / therapy*