[Vulvar dysplasia]

The histological picture of severe stage dysplasia or undifferentiated vulvar intraepithelial neoplasia III is similar in three clinical entities, which should be distinguished because they differ with regard to clinical characteristics, development, prognosis and treatment. They are: 1. Bowen's disease in the menopausal female, which is a precancerous state that in 10 to 30% of cases develops to invasive epidermal cancer. Surgical excision is required. 2. Bowen's papulosis in the young female, known only since the last 2 decades, is the most frequent. It is clinically highly polymorphic. Since it can regress spontaneously and short- and mid-term malignant transformation is rare, conservative treatment should be given. 3. Extensive, patchy Bowen's papulosis in the young female is associated with intraepithelial cervical neoplasia in 85% of cases and with immune deficiency in 30% of cases. Fortunately, it is rare because its risk of malignant transformation is high. Its treatment has not been fully defined but should be as conservative as possible. This clinical distinction is not accepted in the English literature but to us seems of major importance given the need to apply appropriate treatment in each case.