Cancer and Intraepithelial Neoplasia of the Vulva and Vagina

Approximately 70% of all cancers of the vagina and 40% of vulval cancers are associated with high grade human papillomavirus (HPV). The corresponding prevalence in vulval intraepithelial neoplasia (VIN) 2/3 and vaginal intraepithelial neoplasia (VAIN) 2/3 lesions is in the range of 85–95%. While there is no efficient screening for these neoplasms in the general population, risk groups such as immunocompromised women and patients with a history of cervical intraepithelial neoplasia may benefit from colposcopy follow-up. Frank invasive cancers are a clinical diagnosis but most preinvasive lesions are diagnosed by colposcopy with biopsies. There are two distinct entities of VIN and squamous cell cancer of the vulva. HPV is linked to the common undifferentiated VIN and basaloid cancers while the rare differentiated VIN and the keratinizing cancers are HPV-negative. Lichen sclerosus seems to play a role in the genesis of these tumors. Surgery is the treatment of choice for preinvasive and early tumors, although application of imiquimod is another option for VIN2/3.