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Vulväre Präkanzerosen

Diagnostik und Therapie

Vulvar intraepithelial neoplasia

Diagnosis and therapy

  • CME Weiterbildung · Zertifizierte Fortbildung
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Zusammenfassung

Die HPV-induzierte klassische vulväre intraepitheliale Neoplasie (VIN) ist die häufigste Präkanzerose der Vulva (90%). Die Inzidenz der Erkrankung hat zugenommen und liegt derzeit bei 5–7/100.000 Frauen/Jahr, der Altersmedian liegt bei 46 Jahren. Die Erkrankung kann multifokal auftreten und multizentrisch. Die nicht HPV-assoziierte differenzierte VIN ist selten und tritt v. a. bei älteren Frauen auf. Die Beschwerden sind unspezifisch mit Juckreiz, Brennen oder tastbarer Veränderung. Die Diagnose erfolgt kolposkopisch mittels Stanzbiopsie. Die Standardtherapie ist die chirurgische Entfernung im Gesunden (Exzision oder Lasertherapie). Das Immunmodulans Immiquimod zeigt gute Heilungsraten, ist aber für die Erkrankung nicht zugelassen und deshalb nur im „Off-Label-Use“ einsetzbar. Die zweithäufigste prämaligne Läsion ist der M. Paget. Die kolposkopische Verdachtsdiagnose wird über eine Biopsie gesichert. Auch hier besteht die Therapie in der weiten/tiefen Exzision oder Laservaporisation. Die Rezidivrate ist hoch.

Abstract

Human papilloma virus (HPV)-induced vulvar intraepithelial neoplasia (VIN) is the most common premalignant lesion of the vulva (90% of VIN). The incidence of this disease has increased over the last decades, and is presently approximately 5–7/100,000 women/year in Germany. The median age of affected women is 46 years, and the disease is often multifocal and multicentric. Non-HPV-induced VIN is rare (10%) and is mainly found in older women. The symptoms of women presenting with VIN are often unspecific, such as itching and burning sensations or a palpable lesion, and the diagnosis is made by colposcopy and biopsy. The standard therapy is complete excision with free margins either surgically or by laser vaporization. The immunomodulator imiquimod is highly effective but not licensed for this disease but may be applied in off-label use. The second most common premalignant lesion is Paget’s disease, and a biopsy is used to verify the diagnosis suspected by colposcopy. Therapeutic intervention consists of wide excision or laser vaporization and recurrences are frequent.

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  1. Universitätsfrauenklinik, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Hampl, G. Bauerschmitz & W. Janni

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  1. M. Hampl
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  2. G. Bauerschmitz
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  3. W. Janni
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Correspondence to M. Hampl.

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Hampl, M., Bauerschmitz, G. & Janni, W. Vulväre Präkanzerosen. Gynäkologe 44, 291–302 (2011). https://doi.org/10.1007/s00129-010-2751-x

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