vulvar intraepithelial neoplasia

Introduction

Dysplastic or neoplastic changes in the vulvar squamous epithelium.

Etiology

• vulvar lichen sclerosus

Epidemiology

• most often occurs in postmenopausal women

Clinical manifestations

• most patients are asymptomatic
• pruritus is the most common symptom
• well circumscribed rough, keratinized white lesions
• red, brown, gray, black or hyperpigmented lesions may also be present
• may be unifocal or multifocal
• lesions are generally raised, but may be macular
• vulvar macular erythema is one presentation
• dysuria or pain on urination may result from contact of urine with the abnormal vulva (GRS9)

Laboratory

• biopsy confirms diagnosis
  • several biopsies may be required

Management

• wide local excision
• imiquimod 5% often effective in HPV-positive women
• prognosis: rarely a precursor to invasive disease

More general terms

• intraepithelial neoplasia
• vulvar dystrophy (vulvar disorder)