In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Mario Preti to discuss the ESGO, ISSVD, ECSVD, and EFC consensus statements on pre-invasive vulvar lesions. Dr. Preti received his Specialization in Gynecology and Obstetrics and Specialization in Medical Oncology at the University of Torino. He is Associate Professor at the Department of Surgical Sciences, University of Torino, Italy, and the Immediate Past President of the ISSVD (International Society for the Study of Vulvo-vaginal disease). Dr. Preti is the author of 4 books on vulvo-vaginal diseases, and as of June 2022, he has published 108 papers indexed in Scopus/Pubmed, with 2,014 citations and an H-index of 23.

Highlights:

Epidemiological data show no decrease in vulvar invasive cancer incidence. This means that accurate diagnosis and treatment of pre-invasive vulvar disease must be improved: these are among the ESGO-ISSVD-ECSVD aims.

The two carcinogenic pathways of vulvar squamous neoplasia recognize as precursors two vulvar intraepithelial neoplasia (VIN): HPV-associated squamous intraepithelial lesions (High Grade VIN) and HPV-independent VIN (mainly differentiated VIN). These precursors have different clinical approach, treatment and oncological risk. Their histologic features can be subtle, and the histological diagnosis may be further complicated by coexisting conditions.

For differentiated VIN, an excisional procedure must always be adopted. Medical treatment (imiquimod or cidofovir) and ablative treatment can be considered for high grade VIN to preserve anatomy and function. These conservative approaches must be preceded by representative biopsies to exclude invasive disease.

Follow up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).