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

Lebreton, Mathilde; Carton, Isis; Brousse, Susie; Lavoué, Vincent; Body, G.; Lévèque, Jean; Nyangoh-Timoh, Krystel

doi:10.1016/j.jogoh.2020.101801

Cited by 21 publications

(49 citation statements)

References 67 publications

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“…Vulvar condyloma/condylomatous low-grade squamous intraepithelial lesions (LSIL) are usually associated with low-risk HPV infections (HPV 6 or 11 in 90% of cases). 10 They do not progress to invasive cancer and are common in the general population with a prevalence of around 107-229 per 100 000 women. 11 12 Vulvar high-grade squamous intraepithelial lesions (VHSIL) are seen with an incidence of 2.5 to 8.8 per 100 000 women/year and may have a risk of transforming into an invasive carcinoma.…”

Section: Epidemiologymentioning

confidence: 99%

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) consensus statements on pre-invasive vulvar lesions

Preti

Joura

Vieira‐Baptista

et al. 2022

Int J Gynecol Cancer

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The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget’s disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).

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Section: Epidemiologymentioning

confidence: 99%

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) consensus statements on pre-invasive vulvar lesions

Preti

Joura

Vieira‐Baptista

et al. 2022

Int J Gynecol Cancer

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“…Prominent risk factors for developing VIN include increasing age, smoking, immunosuppression, human papilloma virus (HPV) infection, cervical dysplasia, and vulvar dermatosis such as lichen sclerosus. 3 Like cervical dysplasia, the majority of VIN is associated with HPV infection, which is thought to induce disordered cellular proliferation via the production of viral oncoproteins. 2 In one histologic case series of 587 VIN tissue samples, HPV was detected in 86.7% of samples, with HPV 16, 33, and 18 being the most prevalent genotypes.…”

Section: Epidemiology and Terminologymentioning

confidence: 99%

“…Patients may describe symptoms of pruritus, irritation, pain, dyspareunia, and bleeding; 70% of patients with vHSIL will be symptomatic. 3 Assessment of vulvar lesions should include anatomic site, size, focality (single or multifocal), shape, border regularity, color, thickness, and abnormal vasculature. Vulvar colposcopy after application of acetic acid may be used to aid in diagnosis, especially in patients who are symptomatic but do not have visually apparent lesions.…”

Section: Diagnosismentioning

confidence: 99%

“…1,3 The presentation of vHSIL is variable, and can present as opaline or pigmented macules, papules, or plaques located near the introitus. 3 On the other hand, dVIN typically presents in the background of lichen sclerosus (diagnosis and treatment of lichen sclerosus is beyond the scope of this review). Patients with dVIN lesions may present with maculopapular plaques with irregular warty or leukoplakic appearance.…”

Section: Diagnosismentioning

confidence: 99%

“…Patients with dVIN lesions may present with maculopapular plaques with irregular warty or leukoplakic appearance. 3 Both vHSIL and dVIN lesions may involve some degree of erythema. Clinical judgment guides decision to biopsy.…”

Section: Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Vulvar Intraepithelial Neoplasia (VIN): Diagnosis and Management

Huang,

Lokich

2022

Topics in Obstetrics &Amp; Gynecology

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