Clinical case: differentiated intraepithelial neoplasia of the vulva (DVIN). Management and treatment tactics

Differentiated vulvar intraepithelial neoplasia (dVIN) is associated with lichen sclerosis planus and progression to invasive lesions, particularly vulvar squamous cell carcinoma. The recurrence rate of dVIN is significantly higher than that of undifferentiated VIN (uVIN). Therapeutic approaches include surgical excision with scalpel, electroexcision, or laser therapy; wide local excision is considered the preferred initial approach. Although immunohistochemistry is a valuable tool in differential diagnosis, evaluation of p53 protein expression is not a completely reliable marker for dVIN: mutant p53 expression in the basal layer of the dVIN epithelium may mimic the enhanced expression seen in reactive changes, and not all cases of dVIN are accompanied by mutations in the TP53 gene.