title: Medical and surgical approaches to vulvar intraepithelial neoplasia.
abstract: Vulvar intraepithelial neoplasia (VIN) is a precursor to invasive vulvar carcinoma. The two major types of VIN, usual and differentiated, differ in epidemiology, pathogenesis, clinical manifestations, pathology, and malignant potential. Usual VIN commonly occurs in younger women. It is associated with human papillomavirus and tends to have multifocal and multicentric involvement. Differentiated VIN is frequently associated with benign vulvar dermatoses such as lichen sclerosus and lichen simplex chronicus. It occurs in older women and typically is unifocal and unicentric. Clinicians must have a high suspicion for VIN, which is diagnosed by biopsy. Surgical excision has been the standard treatment in order to prevent progression to invasive disease. The objectives of treatment have expanded to include preservation of normal vulvar function and anatomy. Therefore, management options are being investigated, including topical therapy, laser excision and vaporization, and photodynamic therapy. All can be effective in both eliminating disease and maintaining relatively normal-appearing and functioning anatomy.
authors.affiliation: Department of Dermatology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA. kimberly_lai@urmc.rochester.edu
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Lai
authors.forename: Mary Gail
authors.initials: MG
authors.lastname: Mercurio
mesh_terms: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy* / Q000821:virology; D000077404:Cidofovir; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D000077271:Imiquimod; D053685:Laser Therapy / Q000379:methods; D063065:Organophosphonates / Q000627:therapeutic use; D010778:Photochemotherapy; D014846:Vulvar Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy* / Q000821:virology
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000964:Antimetabolites, Antineoplastic; D000998:Antiviral Agents; D063065:Organophosphonates; D003596:Cytosine; D000077404:Cidofovir; D000077271:Imiquimod; D005472:Fluorouracil