Squamous Precursor Lesions of the Vulva: A Practical Approach

Area of Science:

• Gynecologic Oncology
• Pathology
• Molecular Biology

Background:

• Vulvar squamous cell carcinoma (VSCC) and its precursors exhibit significant biological heterogeneity.
• Classification into human papillomavirus (HPV)-associated, HPV-independent TP53-mutated, and HPV-independent TP53-wild type subgroups is established.
• Evolving terminology exists for precursors within the TP53-wild-type subgroup.

Purpose of the Study:

• To highlight the importance of accurate classification of VSCC precursors.
• To emphasize the distinct biological characteristics and clinical implications of the three VSCC precursor subgroups.
• To underscore the need for precise terminology, particularly for the TP53-wild-type subgroup.

Main Methods:

• Integrated assessment of clinical presentation.
• Histopathological examination.
• Immunophenotypic analysis, focusing on p16 and p53 expression.

Main Results:

• Accurate classification is essential due to differing prognosis, progression risk, and recurrence rates among subgroups.
• Established nomenclature exists for HPV-associated high-grade squamous intraepithelial lesions and TP53-mutated differentiated vulvar intraepithelial neoplasia.
• The terminology for TP53-wild-type precursors is still developing.

Conclusions:

• Vulvar squamous cell carcinoma precursors are biologically distinct, necessitating accurate classification.
• Diagnosis requires a comprehensive approach integrating clinical, histopathological, and immunophenotypic data.
• Continued refinement of terminology for the TP53-wild-type subgroup is important for clinical practice.