The incidence of premalignant vulval intraepithelial neoplasia has increased over the last 20 years, particularly in young women who smoke. The average age is now 35. Furthermore, these lesions are potentially more aggressive with risk of progression and recurrence. Current literature concentrates on the role of human papillomavirus (HPV) on vulval intraepithelial neoplasia (VIN), which has identified HPV 16 as the most common, followed distantly by HPV 18, 33 and 39. The risk of VIN is higher in the ever-increasing numbers of women infected with HIV. Many women are symptomatic describing burning, soreness and pruritus. Diagnosis is by biopsy only, with treatments divided into excisional and ablative. Newer therapeutic modalities include photodynamic therapy, antiviral agents and immunization against HPV. Long-term follow-up is essential to reduce the potential risk of vulvar malignancy.
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