Vulvar intraepithelial neoplasia: a current problem

Vulvar intraepithelial neoplasia (VIN) is a pathological denomination coined by the International Society for Study of Vulvo- vaginal Diseases (ISSVD) and adopted by the International Society of Gynaecological Pathology (ISGYP) and by the World Health Organization. VIN is a heterogeneous pathological entity with a usual type (warty, basaloid and mixed) and a differentiated type. The incidence of the disease is increasing, especially in young women. The high- risk human papilomavirus (HR- HPV) infection, human immunodeficiency virus (HIV) infection, smoking, cervical, vaginal and rectal intraepithelial neoplasia are considered to be high risk factors for development of VIN. There are no specific symptoms or vulvar macroscopic aspects of VIN. However, a clinical lesion is always present. Liberal vulvar biopsies under colposcopy guidance should be done. Patients with diagnosis of VIN harbor an increased risk for vulvar invasive cancer. Surgical excision and laser CO2 vaporization are the most popular therapeutic modalities for VIN treatment, both with high rates of recurrence. A close follow- up of the patients is advised. Topical imiquimod seems to be a promising treatment option. Probably, prophylactic vaccination against HR- HPV will be an important tool for VIN prevention.