In 2004, issvd replaced the previous three-grade classification system with a single-grade system, in which only high-grade disease is classified as vin (. Traditionally, squamous vin was classified into three grades, analogous to the three-grade cervical intraepithelial neoplasia classification. Flat lesions associated with basal atypia and koilocytic changes (formerly termed vin 1) are considered lsil (condyloma or hpv effect) in the current 2015 issvd classification system (4). The bivalent hpv vaccine (subtype 16, 18) has not been studied for vulvar hsil (vin usual type) prevention. Skinning vulvectomy, which removes all vulvar skin, is rarely needed, although it may be useful for cases of confluent multifocal lesions, which can occur in women who are immuno-compromised.
Management of vulvar intraepithelial neoplasia
Vulva intraepithelial neoplasia. Furthermore, it has a higher recurrence rate (. Treatment is recommended for all women with vulvar hsil (vin usual type). Although spontaneous regression has been reported, vin should be considered a premalignant condition, as shown by a case series of 405 new zealand women with vin (. Cigarette smoking is strongly associated with vulvar hsil (vin usual type), and cessation should be encouraged. 12 months after initial treatment should be monitored by visual inspection of the vulva annually thereafter. In that system, vin is subdivided into usual type vin (including warty, basaloid, and mixed vin) and differentiated vin.
Because of the potential for occult invasion, wide local excision should be performed if cancer is suspected, even if biopsies show vulvar hsil. Based on the 2015 issvd terminology of vulvar squamous intraepithelial lesions (4), usual type vin is now classified as vulvar hsil, and differentiated vin remains the same. Other intraepithelial vulvar neoplasms, such as paget disease and melanoma in situ, are rare (see table 1).