Recent Updates in Classification and Management of Premalignant Lesions of Vulva

Premalignant lesions of vulva include squamous intraepithelial lesions such as vulvar intraepithelial neoplasia (VIN) and nonsquamous intraepithelial lesions (SILs) such as melanoma in situ and Paget’s disease. It is important to recognize the vulvar premalignant lesions and treat them to prevent vulvar cancer. Pruritus is a common symptom but it can be asymptomatic also. VIN includes two distinct entities – high-grade SIL (vulvar HSIL [VHSIL]) and differentiated type VIN (dVIN). VHSIL is associated with human papillomavirus infections and is seen in younger women while dVIN occurs in older women associated with lichen sclerosis. dVIN has a higher risk of progression to invasive cancer and mandates surgical treatment. VHSIL can be managed by medical, ablative as well as surgical methods.