Premalignant vulvar disorders

Abstract

A number of premalignant conditions affect the vulva. This article considers vulvar intraepithelial neoplasia (VIN), vulvar Paget's disease and lichen sclerosus. The malignant potential of these uncommon conditions is difficult to accurately assess, but is reported to be up to 5% for VIN and lichen sclerosus. Vulvar Paget's disease is strongly associated with carcinoma - this may be underlying the vulvar lesion (in up to 20%) or a distant primary (in 20-30%). The management of VIN is primarily surgical, with a trend away from radical surgery towards more conservative wide local excision. The incidence of VIN is increasing, while the incidence of vulval cancer remains constant. The greatest increase in VIN is seen in younger women in whom there is a strong association with human papilloma virus (HPV) infection. Wide local excision of vulvar Paget's is recommended. There is a high recurrence rate for both of these conditions. Early referral for assessment and tailoring the management of these patients on an individual basis may help reduce long-term morbidity. The management of lichen sclerosus is mainly medical, with topical steroids used for symptom control. For all of these conditions long-term follow up is recommended in view of the risk of malignant transformation. (C) 2000 Harcourt Publishers Ltd.