Pre-neoplastic lesions of the vulva

Preneoplastic lesions of the vulva have to be considered lesions "at risk" of facilitating the occurrence of invasive vulvar cancer. The Author examines the two categories of lesions commonly considered at risk for invasive epidermoid carcinoma of the vulva, carcinoma in situ and vulvar dystrophies. Carcinoma in situ of the vulva is characterized by an extreme clinical diversity contrasting with a remarkable uniformity of histologic pattern. The author describes two different clinical patterns, the young female type and the post-menopausal type. According to the new virologic progress, three conclusions may be drawn: 1) Oncogenic HPV is the common aetiology of all the carcinomas in situ of the vulva, whatever the clinical type; 2) Oncogenic HPV may directly induce any type of carcinoma in situ; 3) Oncogenic HPV possesses a very special carcinogenic effect with a long period of ascending trophism. Among the dystrophies, the hyperplastic one is the most at risk. The Author discusses the real autonomy of this entity. He concludes that hyperplastic dystrophy per se does not exist and it is always a mixed dystrophy.