Management of precancerous states of the vulva: pathogenesis, diagnosis and treatment
Affiliation and adress for correspondence

Katedra i Klinika Ginekologii i Ginekologii Onkologicznej Gdańskiego Uniwersytetu Medycznego.
Pełniący obowiązki Kierownika: dr n. med. Dariusz Wydra
Correspondence to: Jacek J. Sznurkowski, Katedra i Klinika Ginekologii i Ginekologii Onkologicznej Gdańskiego Uniwersytetu Medycznego,
ul. Kliniczna 1A, 80-402 Gdańsk, tel.: 0 583 493 436, e-mail: jacek.sznurkowski@amg.gda.pl
Source of financing: Department own sources

CURR. GYNECOL. ONCOL. 2009, 7 (3), p. 184-191
ABSTRACT

Vulvar tumors make up for about 5% of all genital malignancies in the females and are a very heterogenous group in terms of histogenesis. This results in great variety of benign and malignant lesions developing within the vulvar area. From the clinical point of view, the most important entity is squamous cell carcinoma of the vulva (SCC), where the coefficient of incidence is estimated at 0.1-2.6 per 100 000, depending on population and location. Worldwide mean incidence is 1.2 per 100 000. Currently, two main forms of SCC are recognized, essentially different in terms of etiology, epidemiological profile, pathogenesis and morphological-clinical appearance: vulvar cancer associated with human papilloma virus (HPV) infection (SCC-HPV-linked) and vulvar cancer not linked with HPV infection (SCC-non-HPVlinked). In its natural course, SCC is preceded by precancerous conditions, defined as vulvar intraepithelial neoplasia (VIN). Histopathological features of VIN also depend on presence or lack of HPV infection. Routine diagnostic workup of VIN includes: clinical examination, colposcopic study (vulvoscopy), photodynamic diagnosis (PDD), cytologic study of cells collected from vulvar surface, histological study of biopsy specimens, other studies (aspiration/fine needle biopsy of lymph nodes), positron emission tomography (PET). Treatment of precancerous conditions may be conservative (Aldara, 5-FU) or surgical. The aim of this paper was to analyze current literature and systematization of information concerning vulvar malignancies, particularly SCC, with particular emphasis on its epidemiology and pathogenesis. Modern diagnostic and therapeutic modalities used in the management of precancerous conditions are presented.

Keywords: vulvar cancer, undifferentiated VIN, HPV, vulvar intraepithelial neoplasia, Aldara, Efudex