Keywords
Lichen sclerosus
Vulvar squamous cell carcinoma
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Abstract
Objective: To analyze the main clinical, diagnostic, and therapeutic characteristics of Differentiated Vulvar Intraepithelial Neoplasia (dVIN). Methods: A narrative literature review was conducted using the PUBMED/MEDLINE, COCHRANE, ACOG, and RCOG databases, with the descriptors “differentiated vulvar intraepithelial neoplasia” and “neoplasia intraepitelial vulvar diferenciada.” Articles published between January 2018 and January 2024, written in English or Portuguese, with full-text access and a specific focus on dVIN, were included. After screening based on eligibility criteria, nine studies were selected and analyzed regarding methodological design, objectives, and main findings. Results: dVIN is a precursor lesion of keratinizing squamous cell carcinoma of the vulva, characterized by an HPV-independent etiology and a predominance in postmenopausal women. It is frequently associated with lichen sclerosus and TP53 gene mutations, exhibiting a keratinizing histologic architecture and a higher neoplastic progression rate. Diagnosis is histopathological, supported by immunohistochemical markers such as p53, Ki-67, and GATA3. The treatment of choice is surgical excision with clear margins; ablative and topical approaches are contraindicated. Systematic clinical follow-up is essential due to the risk of recurrence. Final considerations: dVIN represents a clinically relevant premalignant entity. Early detection, histopathological confirmation, and appropriate surgical management are crucial to preventing progression to invasive carcinoma and improving prognosis.
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