Human papillomavirus and vulval intraepithelial neoplasia

Autor: Dynes T. McConnell
Rok vydání: 2003
Předmět:
Zdroj: Reviews in Gynaecological Practice. 3:201-205
ISSN: 1471-7697
DOI: 10.1016/j.rigp.2003.08.001
Popis: It is now accepted that there is a strong association between vulval intraepithelial neoplasia (VIN) and human papillomavirus (HPV) skin infection. HPV oncogenic subtype infection and altered p53 tumour suppressor function contribute to risk of malignant transformation of VIN, but other factors may be important such as HLA class 1 status and cellular immune mechanisms. The long-term cumulative risk of developing vulval squamous carcinoma following the diagnosis of high grade VIN diagnosis is thought to be approximately 6% per decade, but observational data supporting this is mostly non-population-based and retrospective. Unifocal asymptomatic VIN in younger women may have a lower malignant potential than in older women. Immunocompromised women with multifocal or multicentric squamous intraepithelial neoplasia of the lower genital tract may be at greater risk. Surgical treatments of VIN may reduce the risk of malignant transformation, but recurrence rates are high, and treatment related morbidity is common. Although the standard of care is considered to be excisional surgery, conservative management of asymptomatic high grade VIN in sexually active younger women may be a sensible option if disease involves the forchette or periclitoral areas. Fully informed consent should be documented if conservative management is chosen and surgery should be performed subsequently if lesions become symptomatic or if visual progressive changes occur whilst under surveillance. New treatments being researched include photodynamic therapy (PDT), human papillomavirus vaccines, immunotherapy, and immune modulators. The advantages of these new modalities over surgery is the potential to preserve body image and sexual functioning whilst targeting cellular dysfunction.
Databáze: OpenAIRE
Externí odkaz: