Vulvar Intraepithelial Neoplasia
No standard screening programs are manageable to detect vulvar carcinoma or its precursor lesions, and therefore gynecologists, dermatologists, and other healthcare providers in the field of vulvar disorders should be aware of the clinical features, behav
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Fabrizio Bogliatto
55.1 Introduction Vulvar intraepithelial neoplasia (VIN) is a premalignant vulvar skin disorder that often causes severe and long-lasting pruritus, pain, and psychosexual dysfunction. The incidence of this disorder is increasing, particularly in young women. Recent surveillance data from the United States shows the incidence has increased more than fourfold in 30 years [1]. While spontaneous regression may occur in a subset of those with this condition, vulvar intraepithelial lesions should be considered a precancerous disease. It is impressive that in a case series of 405 women with VIN [2], 10 untreated cases progressed to invasion in a mean of 3.9 years. In addition, it is noteworthy that an occult invasive cancer was reported in 3% of women undergoing surgery for VIN [3]. The annual incidence of vulvar intraepithelial lesions (from 1999–2004) has been reported as 1.2/100,000 with a peak in women aged 45–49 years [4]. The overall human papilloma virus (HPV) prevalence in vulvar intraepithelial lesions is 80.4% with HPV 16 the most common subtype (71.2%) followed by HPV 33 [5]. The clinical characteristics, the outcome following surgical treatment, and the natural history of VIN, and consequently the terminology, began
F. Bogliatto (*) Department of Obstetrics and Gynaecology, Lower Female Anourogenital Tract Network, Chivasso Civic Hospital, Turin, Italy
to be clarified in the 1980s, along with the identification of the HPV infection.
55.2 Historical Background In 1912, John Bowen [6] described for the first time in a young man a precancerous dermatosis on the gluteal region that, even if it recurred several times after local therapy, never progressed to invasive cancer. In 1922, Hudelo [7] described, for the first time in a woman, a similar multifocal lesion on the vulva. Until 1943, in the literature 31 cases of the so-called Bowen’s disease of the vulva have been described. The first series of Bowen’s disease of the vulva was described by Knight and co-workers in 1943 [8]. From that time, more than ten different names have been used to describe this vulvar disease, such as erythroplasia of Queyrat, bowenoid papulosis, bowenoid dysplasia, hyperplastic dystrophy with atypia, condylomatous dysplasia, carcinoma simplex, dysplasia, or carcinoma in situ. This confusion was principally due to the fact that the vulva is approached by different medical specialists (gynecologists, dermatologists, pathologists) with their own set of terminologies and classifications and to the fact that vulvar intraepithelial neoplasia had a lack of specific macroscopical features, the histopathological aspect of the lesion did not correlate with a specific histological pattern, and both the macroscopic aspect and histology did not correlate with the prognosis.
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_55
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This lack of definition has also led to consider as toses such as lichen
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