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

Area of Science:

• Gynecologic Oncology
• Dermatology
• Pathology

Background:

• Vulvar intraepithelial neoplasia (VIN) comprises two distinct entities: differentiated VIN (dVIN) and vulvar high-grade squamous intraepithelial lesions (vH-SIL).
• dVIN arises from existing vulvar lesions like lichen sclerosus, whereas vH-SIL is linked to HPV infection.
• These subtypes exhibit significant differences in pathophysiology, clinical presentation, prognosis, and therapeutic approaches.

Purpose of the Study:

• To review the current literature on vulvar intraepithelial neoplasia (VIN).
• To differentiate between dVIN and vH-SIL based on their unique characteristics.
• To discuss the challenges and current lack of consensus in managing VIN.

Main Methods:

• Comprehensive literature review of studies on VIN.
• Analysis of differentiating factors between dVIN and vH-SIL.
• Examination of current and alternative management strategies.

Main Results:

• VIN classification includes dVIN and vH-SIL, with distinct origins and associations.
• The incidence of VIN is increasing, particularly in younger women.
• Recurrence rates for VIN remain high, even post-surgery, leading to potential disfigurement.

Conclusions:

• Effective management of VIN requires distinguishing between dVIN and vH-SIL.
• Alternative treatments like topical therapies, ablation, and watchful waiting are explored.
• Further research and consensus are needed for optimal VIN management strategies.