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Vulvar intraepithelial neoplasia
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of vulvar intraepithelial neoplasia are prepared by our editorial team based on guidelines from the British Gynaecological Cancer Society (BGCS 2020), the British Photodermatology Group (BPG/BAD 2019), and the American College of Obstetricians and Gynecologists (ACOG 2016).
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Screening and diagnosis
Diagnostic investigations
Diagnostic procedures
Vulvar biopsy
As per ACOG 2016 guidelines:
Perform biopsy for visible vulvar lesions in the following situations:
definitive diagnosis cannot be made clinically
possible malignancy
presumed clinical diagnosis not responding to usual therapy
atypical vascular patterns
stable lesions rapidly changing in color, border, or size
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Perform a biopsy in postmenopausal patients with apparent genital warts and in female patients of all ages with suspected condyloma if topical therapies have failed.
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Medical management
Indications for treatment: as per ACOG 2016 guidelines, offer treatment in all patients with vulvar high-grade squamous intraepithelial lesions (VIN usual type).
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Topical imiquimod
Topical cidofovir
Therapeutic procedures
Laser ablation: as per ACOG 2016 guidelines, consider offering laser ablation as a treatment option in patients with vulvar high-grade squamous intraepithelial lesions (VIN usual type) if an occult invasion is not a concern.
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Photodynamic therapy
Surgical interventions
Preventative measures
Smoking cessation: as per ACOG 2016 guidelines, advise smoking cessation as it is strongly associated with vulvar high-grade squamous intraepithelial lesions (VIN usual type).
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HPV vaccination