Risk Factors and Classification of Vulvar Intraepithelial Lesions

  • Kiran Abhijit Kulkarni
  • Geeta Acharya
  • G. Sumangala


The history of vulvar intraepithelial neoplasia (VIN) dates back to more than a century.

Over the last few years, vulvar intraepithelial lesions have shown an increasing trend with a propensity of presenting at a younger age (Judson et al., Obstet Gynecol 107:1018–1022, 2006). However, the incidence of vulvar squamous cell carcinoma (VSCC) does not show a proportionate rise (Bodelon et al., Cancer Causes Control 20(9):1779–1782, 2009). The terminology and classification of vulvar intraepithelial lesions have been quite confusing and revised multiple times by the World Health Organization (WHO) and International Society for the Study of Vulvovaginal Disease (ISSVD) over the years. Two distinct oncogenic pathways have been described: human papillomavirus (HPV)-related and non-HPV-related. Low-risk HPV 6 and 11 are associated with low-grade squamous intraepithelial lesions (LSIL), whereas high-risk HPV (16, 18, 31, 33) are associated with high-grade squamous intraepithelial lesions (HSIL). Chronic dermatologic conditions such as lichen sclerosus are associated with differentiated VIN (dVIN), which carries a higher risk of progression to carcinoma compared to HPV-related lesions.

The common risk factors associated with VIN and progression to cancer are age, immunosuppression, smoking, sexual behaviour and chronic dermatologic conditions like lichen sclerosus, and these will be dealt in detail in this chapter.


Vulvar intraepithelial neoplasia LSIL HSIL dVIN Lichen sclerosus Vulvar squamous cell carcinoma HPV 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Kiran Abhijit Kulkarni
    • 1
  • Geeta Acharya
    • 1
  • G. Sumangala
    • 1
  1. 1.Department of Gynaecological OncologySt. John’s Medical College and HospitalBangaloreIndia

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