{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T08:38:04Z","timestamp":1776847084818,"version":"3.51.2"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T00:00:00Z","timestamp":1649030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The spectrum of vulvar lesions ranges from infective and benign dermatologic conditions to vulvar precancer and invasive cancer. Distinction based on the characteristics of vulvar lesions is often not indicative of histology. Vulvoscopy is a useful tool in the examination of vulvar pathology. It is more complex than just colposcopic examination and presumes naked eye examination accompanied by magnification, when needed. Magnification can be achieved using a magnifying glass or a colposcope and may aid the evaluation when a premalignant or malignant lesion is suspected. It is a useful tool to establish the best location for biopsies, to plan excision, and to evaluate the entire lower genital system. Combining features of vulvar lesions can help prediction of its histological nature. Clinically, there are two distinct premalignant types of vulvar intraepithelial neoplasia: HPV-related VIN, more common in young women, multifocal and multicentric; VIN associated with vulvar dermatoses, more common in older women and usually unicentric. For definite diagnosis, a biopsy is required. In practice, the decision to perform a biopsy is often delayed due to a lack of symptoms at the early stages of the neoplastic disease. Clinical evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer may be present.<\/jats:p>","DOI":"10.3390\/cancers14071822","type":"journal-article","created":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T05:50:43Z","timestamp":1649051443000},"page":"1822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Early Diagnostics of Vulvar Intraepithelial Neoplasia"],"prefix":"10.3390","volume":"14","author":[{"given":"Vesna","family":"Kesi\u0107","sequence":"first","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5335-6770","authenticated-orcid":false,"given":"Pedro","family":"Vieira-Baptista","sequence":"additional","affiliation":[{"name":"Lower Genital Tract Unit, Centro Hospitalar de S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Hospital Lus\u00edadas Porto, 4200-319 Porto, Portugal"}]},{"given":"Colleen K.","family":"Stockdale","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Vulvar Vaginal Disease and Colposcopy Clinics, University Iowa Healthcare, Iowa City, IA 52242, USA"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,4]]},"reference":[{"key":"ref_1","first-page":"807","article-title":"Squamous Vulvar Intraepithelial Neoplasia: 2004 Modified Terminology, ISSVD Vulvar Oncology Subcommittee","volume":"50","author":"Sideri","year":"2005","journal-title":"J. Reprod. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.5858\/arpa.LGT200570","article-title":"The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology","volume":"136","author":"Darragh","year":"2012","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_3","unstructured":"Kurman, R.J., Carcangiu, M.L., Herrington, C.S., and Young, R.H. (2014). Tumors of the Vulva. WHO Classification of Tumours of Female Reproductive Organs, IARC. [4th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/LGT.0000000000000169","article-title":"The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions","volume":"20","author":"Bornstein","year":"2016","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_5","first-page":"1257","article-title":"Vulvar malignancies: An interdisciplinary perspective","volume":"17","author":"Wohlmuth","year":"2019","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000321042","article-title":"Morphology and Physiological Changes of Genital Skin and Mucosa","volume":"40","author":"Farage","year":"2011","journal-title":"Curr. Probl. Dermatol."},{"key":"ref_7","first-page":"126","article-title":"Vulvar Pruritus\u2014Causes, Diagnosis and Therapeutic Approach","volume":"116","author":"Prieske","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/01.lgt.0000229566.57482.f3","article-title":"Cytological Evaluation Correlates Poorly with Histological Diagnosis of Vulvar Neoplasias","volume":"11","author":"Bauer","year":"2007","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/bjc.2011.533","article-title":"Cytology of the vulva: Feasibility and preliminary results of a new brush","volume":"106","author":"Einden","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_10","first-page":"29","article-title":"La vulvoscopia, no debe ser destinada como el examen colposcopico de la vulva","volume":"3","author":"Micheletti","year":"2011","journal-title":"Arch. Med. Actual Tracto Genit. Inf."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, M.G.-Y., Mu\u00f1oz Ledesma, A.M., Monge, M.N., and Font\u00e1n, J.S. (2022, February 09). Colposcopy of the Vulva and Perineum Colposcopy of the Vulva and Perineum. Open Access Peer-Reviewed Chapter September. Available online: http:\/\/dx.doi.org\/10.5772\/intechopen.68768.","DOI":"10.5772\/intechopen.68768"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.ygyno.2019.02.024","article-title":"Prevalence of high-grade anal dysplasia among women with high-grade lower genital tract dysplasia or cancer: Results of a pilot study","volume":"153","author":"Domgue","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/LGT.0000000000000631","article-title":"Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review","volume":"26","author":"Albuquerque","year":"2022","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/LGT.0000000000000490","article-title":"Screening for Anal Cancer in Women With a History of Vulvar High-Grade Squamous Intraepithelial Lesions","volume":"23","author":"Proctor","year":"2019","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.21873\/anticanres.13075","article-title":"An Update on the Current Role of High Resolution Anoscopy in Patients With Anal Dysplasia","volume":"39","author":"Gudur","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00404-015-3666-5","article-title":"Colposcopic acetowhitening of vulvar lesion: A validity study","volume":"292","author":"Santoso","year":"2015","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_17","unstructured":"(2016). Management of vulvar intraepithelial neoplasia. Committee Opinion No American College of Obstetricians and Gynecologists. Obstet. Gynecol., 128, e178\u2013e182."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/PGP.0b013e3181a934d4","article-title":"Accuracy of Preoperative Vulva Biopsy and the Outcome of Surgery in Vulvar Intraepithelial Neoplasia 2 and 3","volume":"28","author":"Polterauer","year":"2009","journal-title":"Int. J. Gynecol. Pathol."},{"key":"ref_19","first-page":"962","article-title":"Vulvar intraepithelial neoplasia III: Occult cancer and the impact of margin status on recurrence","volume":"92","author":"Modesitt","year":"1998","journal-title":"Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/LGT.0b013e31825934c7","article-title":"For the Nomenclature Committee of the International Federation for Cervical Pathology and Colposcopy 2011 Terminology of the Vulva of the International Federation for Cervical Pathology and Colposcopy","volume":"16","author":"Bornstein","year":"2012","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_21","unstructured":"B\u00f6sze, P., and Luesley, D.M. (2007). Colposcopy of the Vulva, Perineum and Anal Canal. EAGC Course Book on Colposcopy, Primed-X Press."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1097\/LGT.0b013e31826a38f3","article-title":"Pigmented Vulvar Lesions\u2014A Pathology Review of Lesions That Are Not Melanoma","volume":"17","author":"Heller","year":"2013","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/595286","article-title":"Vulvar Skin Disorders throughout Lifetime: About Some Representative Dermatoses","volume":"2014","author":"Doyen","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"366","DOI":"10.5114\/ada.2021.107924","article-title":"Vulvar cancer in a patient with long-lasting premalignant lesions in the genital area: Easily overlooked and difficult to diagnose\u2014A case report and literature review","volume":"38","author":"Szatko","year":"2021","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Preti, M., Bucchi, L., Ghiringhello, B., Privitera, S., Frau, V., Corvetto, E., Benedetto, C., and Micheletti, L. (2017). Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy. J. Gynecol. Oncol., 28.","DOI":"10.3802\/jgo.2017.28.e27"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S5.e1","DOI":"10.1016\/j.jadohealth.2008.07.009","article-title":"Age-Specific Prevalence of Infection with Human Papillomavirus in Females: A Global Review","volume":"43","author":"Smith","year":"2008","journal-title":"J. Adolesc. Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Preti, M., Igidbashian, S., Costa, S., Cristoforoni, P., Mariani, L., Origoni, M., Sandri, M.T., Boveri, S., Spolti, N., and Spinaci, L. (2015). VIN usual type\u2014From the past to the future. Ecancermedicalscience, 9.","DOI":"10.3332\/ecancer.2015.531"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/LGT.0b013e318196bd23","article-title":"Vulvar Intraepithelial Neoplasia 3 in Women Less Than 35 Years","volume":"13","author":"Kesterson","year":"2009","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Albuquerque, A., Godfrey, M.A.L., Cappello, C., Pesola, F., Bowring, J., Cuming, T., De Masi, A., Rosenthal, A.N., Sasieni, P., and Nathan, M. (2021). Multizonal anogenital neoplasia in women: A cohort analysis. BMC Cancer, 21.","DOI":"10.1186\/s12885-021-07949-8"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.ejca.2008.11.037","article-title":"Vulvar squamous cell carcinoma development after diagnosis of VIN increases with age","volume":"45","author":"Massuger","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/ijc.33198","article-title":"Vulvar intraepithelial neoplasia: Incidence and long-term risk of vulvar squamous cell carcinoma","volume":"148","author":"Thuijs","year":"2020","journal-title":"Int. J. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Voss, F.O., Thuijs, N.B., Vermeulen, R.F.M., Wilthagen, E.A., van Beurden, M., and Bleeker, M.C.G. (2021). The Vulvar Cancer Risk in Differentiated Vulvar Intraepithelial Neoplasia: A Systematic Review. Cancers, 13.","DOI":"10.3390\/cancers13246170"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2147\/IJWH.S191200","article-title":"Vulvar Lichen Sclerosus: Current Perspectives","volume":"12","author":"Krapf","year":"2020","journal-title":"Int. J. Women\u2019s Health"},{"key":"ref_34","first-page":"951250","article-title":"Two Distinct Pathways to Development of Squamous Cell Carcinoma of the Vulva","volume":"2011","author":"Ueda","year":"2010","journal-title":"J. Ski. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Corazza, M., Schettini, N., Zedde, P., and Borghi, A. (2021). Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects. Biomedicines, 9.","DOI":"10.3390\/biomedicines9080950"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1097\/LGT.0000000000000572","article-title":"Diagnostic Criteria for Differentiated Vulvar Intraepithelial Neoplasia and Vulvar Aberrant Maturation","volume":"25","author":"Heller","year":"2020","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s00428-021-03070-0","article-title":"Histological interpretation of differentiated vulvar intraepithelial neoplasia (dVIN) remains challenging\u2014observations from a bi-national ring-study","volume":"479","author":"Dasgupta","year":"2021","journal-title":"Virchows Arch."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/7\/1822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:49:33Z","timestamp":1760136573000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/7\/1822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,4]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["cancers14071822"],"URL":"https:\/\/doi.org\/10.3390\/cancers14071822","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,4]]}}}