Vulvar intraepithelial neoplasia

Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

“…Application of dilute (3%) acetic acid may result in a more opaque (whiter) appearance to the lesions, although this is not a specific finding on the vulva. 14 The diagnosis is established with biopsy. Raised white, red, or pigmented lesions, and ulcerated lesions are characteristic of invasive vulvar carcinoma.…”

“…[1][2][3][4] A number of factors, including the availability of over-thecounter antifungal medications, 5,6 and patient and provider time pressures and comfort with undertaking a pelvic exam, may lead to an empiric trial of therapy without undertaking a physical exam or diagnostic testing. While the most common causes of these symptoms are BV, vaginal candidiasis and vaginal trichomoniasis, 2,3 the differential diagnosis is broad, and includes vulvar infections, 7 vulvovaginal atrophy, 8,9 reactions to irritants or allergens, 10,11 inflammatory conditions, 12,13 premalignant, 14 and malignant lesions.…”

Vulvar Lichen Sclerosus and Neoplastic Transformation

“…This finding is in agreement with the previously described carcinogenic pathway, which proposes a progression from VLS to keratinizing SCC through dVIN. 2 In contrast, dVIN along with VLS was rarely reported (5%) as adjacent lesion to ISCC. A possible explanation is that the ISCC replaced or obliterated the precursor lesion or that dVIN was not diagnosed or reported in pathological report.…”

“…26 Rapid progression to neoplasia or its underdiagnosis could also explain why dVIN accounts for only 2% to 10% of all reported VIN in the literature. 2 Our study showed that dVIN was frequently found adjacent to SISCC lesions, which implies that careful clinical surveillance could allow for the early identification of dVIN lesions before invasive carcinoma has supervened.…”

“…Specifically, differentiated vulvar intraepithelial neoplasia (dVIN) and subsequently keratinizing squamous cell carcinoma (keratinizing SCC) can develop within VLS. 2 The evaluation of the neoplastic potential of VLS has been carried out in 2 different ways, firstly, through histopathological studies of the lesions adjacent to neoplasms. These studies show that VLS, dVIN, and keratinizing SCC are frequently associated with each other.…”