Detection of Precancerous Lesions of the Vulva

  • T. S. Premalatha
  • Vishakha Chandrakant Bidkar
  • T. Parvathi
  • Elizabeth Vallikad


Vulvar cancer and its precursor lesions are uncommon and hence there are no standard screening programs. The precancerous lesions are often overlooked and are treated as nonspecific dermatologic conditions. Often the patients seek multiple opinions from different specialists for symptom relief. Therefore, the gynecologists, dermatologists, and other healthcare providers in this field should be familiar of the clinical features and detection of the different premalignant vulvar lesions: squamous vulvar intraepithelial neoplasia, vulvar Paget disease, and melanoma in situ. The histopathological diagnosis can sometimes be mistaken especially in differentiated vulvar intraepithelial neoplasias, and a close relationship between clinicians and the pathologists will help to arrive at the correct diagnosis and proper management.


VIN HSIL dVIN EMPD MIS Precancerous lesions of the vulva Vulvar Paget disease Vulvoscopy Collins test 


  1. 1.
    Hoang LN, Park KJ, Soslow RA, Murali R. Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathology. 2016;48(4):291–302. Scholar
  2. 2.
    Van de Nieuwenhof HP, van der Avoort IAM, de Hullu JA. Review of squamous premalignant vulvar lesions. Crit Rev Oncol Hematol. 2008;68:131–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Bornstein J, Bogliatto F, Haefner HK, Stockdale CK, Preti M, Bohl TG, et al. The 2015 ISSVD terminology of vulvar squamous intraepithelial lesions. J Low Genit Tract Dis. 2016;20(2):190.CrossRefGoogle Scholar
  4. 4.
    Van de Nieuwenhof HP, Bulten J, Hollema H, Dommerholt RG, Massuger LF, van der Zee AG, et al. Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma. Mod Pathol. 2010;24(2):297–305.PubMedCrossRefGoogle Scholar
  5. 5.
    Eva LJ, Ganesan R, Chan KK, Honest H, Luesley DM. Differentiated-type vulval intraepithelial neoplasia has a high-risk association with vulval squamous cell carcinoma. Int J Gynecol Cancer. 2009;19:741–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Preti M, Scurry J, Marchitelli CE, Micheletti L. Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1051–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Chanda JJ. Extramammary Paget’s disease: prognosis and relationship to internal malignancy. J Am Acad Dermatol. 1985;13(6):1009–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Iacoponi S, Zalewski K, Fruscio R, Diaz-De la Noval B, De Iaco P, Ceccaroni M, et al. Prognostic factors for recurrence and survival among patients with invasive vulvar Paget disease included in the VULCAN study. Int J Gynaecol Obstet. 2016;133(1):76–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Kingston NJ, Jones RW, Baranyai J. Recurrent primary vulvovaginal malignant melanoma arising in melanoma in situ–the natural history of lesions followed for 23 years. Int J Gynecol Cancer. 2004;14:628–32.PubMedGoogle Scholar
  10. 10.
    Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era. J Am Acad Dermatol. 2012;67(1):19.e1–12.CrossRefGoogle Scholar
  11. 11.
    McNally OM, Mulvany NJ, Pagano R, Quinn MA, Rome RM. VIN 3: a clinicopathologic review. Int J Gynecol Cancer. 2002;12:490–5.PubMedCrossRefGoogle Scholar
  12. 12.
    van Beurden M, ten Kate FJ, Smits HL, Berkhout RJ, de Craen AJ, van der Vange N, et al. Multifocal vulvar intraepithelial neoplasia grade III and multicentric lower genital tract neoplasia is associated with transcriptionally active human papillomavirus. Cancer. 1995;75:2879–84.PubMedCrossRefGoogle Scholar
  13. 13.
    Spitzer M. Lower genital tract neoplasia in HIV-infected women: guidelines for evaluation and management. Obstet Gynecol Surv. 1999;54:131Y7.CrossRefGoogle Scholar
  14. 14.
    Yang B, Hart WR. Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression. Am J Surg Pathol. 2000;24:429–41.PubMedCrossRefGoogle Scholar
  15. 15.
    Hart WR. Vulvar intraepithelial neoplasia: historical aspects and current status. Int J Gynecol Pathol. 2001;20:16e30.CrossRefGoogle Scholar
  16. 16.
    Niikura H, Yoshida H, Ito K, Takano T, Watanabe H, Aiba S, et al. Paget’s disease of the vulva: clinicopathologic study of type 1 cases treated at a single institution. Int J Gynecol Cancer. 2006;16:1212–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Shaco-Levy R, Bean SM, Vollmer RT, Papalas JA, Bentley RC, Selim MA, et al. Paget disease of the vulva: a histologic study of 56 cases correlating pathologic features and disease course. Int J Gynecol Pathol. 2010;29:69–78.PubMedCrossRefGoogle Scholar
  18. 18.
    Delport ES. Extramammary Paget’s disease of the vulva: an annotated review of the current literature. Austral J Dermatol. 2013;54(1):9–21, 2013.CrossRefGoogle Scholar
  19. 19.
    van der Linden M, Meeuwis KAP, Bulten J, et al. Paget disease of the vulva. Crit Rev Oncol Hematol. 2016;101:60–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion–when and how. J Am Acad Dermatol. 2008;59:852–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Murzaku EC, Penn LA, Hale CS, Pomeranz MK, Polsky D. Vulvar nevi, melanosis, and melanoma: an epidemiologic, clinical, and histopathologic review. J Am Acad Dermatol. 2014;71(6):1241–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Sacher BC. The normal vulva, vulvar examination, and evaluation tools. Clin Obstet Gynecol. 2015;58(3):442–52.CrossRefGoogle Scholar
  23. 23.
    Micheletti L, Bogliatto F, Lynch PJ. Vulvoscopy: review of a diagnostic approach requiring clarification. J Reprod Med. 2008;53:179–82.PubMedGoogle Scholar
  24. 24.
    Bornstein J, Sideri M, Tatti S, Walker P, Preniville W, et al. 2011 terminology of the vulva of the international federation for cervical pathology and colposcopy. J Low Genit Tract Dis. 2012;16(3):290–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Collins CG, Hansen LH, Theriot E. A clinical stain for use in selecting biopsy sites in patients with vulvar disease. Obstet Gynecol. 1966;28:158.PubMedGoogle Scholar
  26. 26.
    Ng JC, Swain S, Dowling JP, Wolfe R, Simpson P, Kelly JW. The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol. 2010;146(3):234–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Mir M, Chan CS, Khan F, Krishnan B, Orengo I, Rosen T. The rate of melanoma transection with various biopsy techniques and the influence of tumor transection on patient survival. J Am Acad Dermatol. 2013;68(3):452–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Kurman RJ, Toki T, Schiffman MH. Basaloid and warty carcinomas of the vulva: distinctive types of squamous cell carcinoma frequently associated with human papillomaviruses. Am J Surg Pathol. 1993;17:133e45.Google Scholar
  29. 29.
    Scurry J, Wilkinson EJ. Review of terminology of precursors of vulvar squamous cell carcinoma. J Lower Gen Tract Dis. 2006;10:161Y9.CrossRefGoogle Scholar
  30. 30.
    Hoevenaars BM, van der Avoort IA, de Wilde PC, Massuger LF, Melchers WJ, de Hullu JA, et al. A panel of p16(INK4A), MIB1 and p53 proteins can distinguish between the 2 pathways leading to vulvar squamous cell carcinoma. Int J Cancer. 2008;123:2767Y73.CrossRefGoogle Scholar
  31. 31.
    van der Avoort IA, van der Laak JA, Paffen A, Grefte JM, Massuger LF, de Wilde PC, et al. MIB1 expression in basal cell layer: a diagnostic tool to identify premalignancies of the vulva. Mod Pathol. 2007;20:770Y8.Google Scholar
  32. 32.
    Yang B, Hart WR. Vulvar intraepithelial neoplasia of the simplex (differentiated) type: a clinicopathologic study including analysis of HPV and p53 expression. Am J Surg Pathol. 2000;24:429Y41.Google Scholar
  33. 33.
    Buscema J, Naghashfar Z, Sawada E, Daniel R, Woodruff JD, Shah K. The predominance of human papillomavirus type 16 in vulvar neoplasia. Obstet Gynecol. 1988;71:601–6.PubMedGoogle Scholar
  34. 34.
    Garland SM, Insinga RP, Sings HL, Haupt RM, Joura EA. Human papillomavirus infections and vulvar disease development. Cancer Epidemiol Biomark Prev. 2009;18:1777–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • T. S. Premalatha
    • 1
  • Vishakha Chandrakant Bidkar
    • 1
  • T. Parvathi
    • 1
  • Elizabeth Vallikad
    • 1
  1. 1.Department of Gynaecological OncologySt. John’s Medical College and Hospital, St. John’s National Academy of Health SciencesBangaloreIndia

Personalised recommendations