The diagnosis and management of vulval intraepithelial neoplasia

Key contentHigh-risk human papilloma virus (HPV)-associated vulval high-grade squamous intraepithelial lesions and HPV-independent differentiated vulval intraepithelial lesions represent distinct disease processes with different risks of progression to vulval squamous cell carcinoma.First-line medical management is appropriate for women with biopsy-confirmed vulval high-grade squamous intraepithelial lesions who have been adequately counselled on the risk of occult invasive disease. Topical treatment should be undertaken in the context of a specialist clinic because it is not suitable for all patients.Surgical management is needed for differentiated vulval intraepithelial neoplasia.Learning objectivesTo understand the clinical, histological, and pathological classification of squamous intraepithelial lesions and diagnostic challenges.To be able to contribute to the multidisciplinary investigation and diagnosis of squamous intraepithelial lesions.To understand the basis for patient-centred counselling on the investigation, diagnosis and treatment of suspected squamous intraepithelial lesions.Ethical issuesTreatment must be tailored towards the patient's appreciation of risk and benefit, informed by the clinical and pathological features of the disease.