Vulval intraepithelial neoplasia: current perspectives

The heterogeneous clinical features of vulval intraepithelial neoplasia (VIN), its uncertain and variable natural history, difficulties in the management of certain cases and the frequency of recurrences provide a continuing challenge for gynaecologists. Patients with VIN present to a diverse range of physicians, all of whom provide differing perspectives on the multifarious issues relating to the condition. The importance of VIN relates principally to the symptoms it causes and its potential to progress to invasive vulval cancer. Both the International Society for the Study of Vulvovaginal Diseases and the International Society of Gynaecological Pathologists have stressed the importance of eliminating eponymous terminology and recommend only the term vulval intraepithelial neoplasia (VIN). This terminology includes both squamous and non-squamous varieties (Table 1). The latter includes both Paget's disease of the vulva and melanoma in situ. Non-squamous VIN will not be considered in this paper. Until 30 years ago VIN was an uncommon condition, seen principally in middle and later life. The incidence particularly in younger women has increased significantly since then [1-3]. Since that time the mean age in our unit has fallen from 52.7 years to 35.8 years (Figure 1) [2]. The increasing incidence of the condition parallels similar trends in cervical intraepithelial neoplasia (CIN) and relates at least in part to changing sexual morés, human papilloma virus (HPV) infection, and cigarette smoking.