Depigmentation’s Disorders of the Vulva, Clinical Management

Abstract

The cancer of the vulva is a rare disease with a positive association to poor developing countries. However, the incidence of vulvar cancer in situ nearly doubled in the last two decades and remained relatively stable. The main reason for this increased incidence of vulvar intraepithelial neoplasia (VIN) in women younger than 45 years is due to changes in sexual behavior, first intercourse at early age, multiple sexual partners, and sexually transmitted diseases that were increasing progressively. Furthermore, it is strongly associated with smoking and the increased incidence of HPV infection. The occurrence of early symptoms of VINlike pruritus vulvae, pain, and lichen sclerosus led to early diagnosis to perform the adequate treatment. VIN tends to appear multifocal, while most invasive cancers are unilateral located and appeared with well-circumscribed lesions.

Treatment with Theresienöl – a new option in the management of vulvar leukoplakia

“…It is assumed that VLS and SCHV are genetic immune diseases [ 5 ]. Both are diseases of autoimmune genesis, with genetic predisposition for VLS [ 1 , 5 , 8 ]. Both diseases are more common in postmenopausal women [ 1 , 9 – 11 ]; with VLS there is also a peak in pre-pubertal girls [ 12 – 14 ].…”

“…The term vulvar leukoplakia encompasses various non-inflammatory diseases that lead to skin discoloration of the external genitalia and white coloration. It includes various atrophic and hypertrophic diseases of the vulva, classified as vulvar dystrophies [ 1 ]. Mainly, these are vulvar lichen sclerosus (VLS) and squamous cell hyperplasia of the vulva (SCHV).…”

Vulvar leukoplakia: therapeutic options

“…They have a malignant potential: 3 to 6% for VLS and 2 to 4% for SCHV [ 5 ]. It has been established that VLS patients can develop vulvar squamous cell carcinoma for several years – from 3.3 to 8.8 years [ 22 , 23 ]. About 80% of the cases of invasive squamous cell carcinoma (SCC) of the vulva in elderly patients are associated with untreated, long-term VLS conditions [ 4 ].…”

“…Because of the malignant potential of these diseases, many clinicians advocate that active management of VLS and SCHV can reduce the risk of malignant transformation [ 22 ].…”

“…In some cases such as atypical features, uncertainty of diagnosis, concern for malignancy, or in failed response to treatment, biopsy is mandatory. The gold standard to differentiate these conditions is histological – biopsy [ 22 , 27 ]. Because biopsy is the only way to exclude SCC of the vulva and vulvar intraepithelial neoplasia, it is necessary in our opinion.…”