Vulvar Intraepithelial Neoplasia: A Review of the Disease and Current Management

Abstract

Importance Vulvar intraepithelial neoplasia (VIN) represents an increasingly common, yet challenging diagnosis that shares many common risk factors with cervical intraepithelial neoplasia. However, unlike cervical intraepithelial neoplasia, effective screening and treatment strategies are much less defined for patients with VIN. Objective The objective of this article is to review the underlying risk factors leading to the development of VIN, identify special populations at risk for VIN, and outline acceptable treatment strategies. Evidence Acquisition This literature review was performed primarily using PubMed. Results Vulvar intraepithelial neoplasia can be separated into usual VIN (uVIN) and differentiated VIN (dVIN). The more common uVIN is related to underlying human papillomavirus infection, whereas dVIN occurs in the setting of other vulvar inflammatory conditions such as lichen sclerosis. Differentiated VIN carries a higher risk of progression to invasive malignancy. Extramammary Paget disease is a rare intraepithelial adenocarcinoma unrelated to uVIN and dVIN, although management is similar. Conclusions and Relevance Vulvar intraepithelial neoplasia is a preinvasive neoplasia of the vulva with few robust strategies for surveillance or management. Careful examination with targeted biopsy is warranted for suspicious lesions, and a combination of surgical and medical management can be tailored for individual patient needs. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After reading this article, the learner should be better able to evaluate the epidemiology and pathophysiology of VIN; assess risk for underlying malignancy, especially when comparing uVIN and dVIN; and compare different options for management of VIN including medical and surgical treatments.