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Clinical and Pathologic Features of Vulvar Intraepithelial Neoplasia in Premenopausal and Postmenopausal Women

Nugent, Elizabeth K. MD1; Brooks, Rebecca A. MD1; Barr, Christopher D. PhD2; Case, Ashley S. MD1; Mutch, David G. MD1; Massad, L. Stewart MD1

Journal of Lower Genital Tract Disease: January 2011 - Volume 15 - Issue 1 - p 15-19
doi: 10.1097/LGT.0b013e3181ee2598
Original Articles

Objective. To explore the clinical and pathologic differences between vulvar intraepithelial neoplasia (VIN) in premenopausal and postmenopausal women cared for in a tertiary referral center.

Methods. Between January 1997 and June 2008, 145 women received care at our institution for VIN and VIN-associated squamous cell carcinoma (SCC). All patients' demographic characteristics and recurrence histories were recorded throughout the study period and were retrieved retrospectively. Menopausal status was self-reported at the time of initial diagnosis. χ2, odds ratio, and logistic regression analyses were used.

Results. The median age was 50 years (range = 19-91 y) with 77% (111/145) of patients white, 20% (29/145) African American, and 3% (5/145) other ethinicity. Sixty percent of patients diagnosed with VIN were current smokers, 18% (26/145) were immunocompromised (positive for human immunodeficiency virus/transplant/steroids), and 30% (44/145) had concomitant or previous lower genital tract dysplasia. Vulvar intraepithelial neoplasia or VIN-related cancer recurred in 57 (39%) of 145 patients; of these, 40 (71%) had recurrence of VIN and 18 (29%) had recurrence of cancer. Fifty-one percent (74/145) of patients were menopausal at initial VIN diagnosis. Among women with VIN, the odds of initially presenting with a VIN-related SCC was 3.2 times greater in postmenopausal than in premenopausal women (confidence interval = 1.5-7.1, p < .01), and postmenopausal women were more likely to present with stage II to IV SCC (p = .021). Recurrence risk of SCC, but not VIN, was associated with menopause status (p < .05).

Conclusions. Among women with VIN, the risk of SCC is higher in postmenopausal than in premenopausal women both initially and at recurrence. Excisional therapies to identify occult invasion are especially important for postmenopausal women with VIN.

Squamous cell carcinomas are more common in postmenopausal women with VIN; excisional therapies should be preferred for older women.

1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO; and 2Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX

Correspondence to: Elizabeth K. Nugent, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, 4th Floor Maternity, St Louis, MO 63110. E-mail:

This study was supported by a department grant.

Authors have no conflicts of interest to declare.

©2011The American Society for Colposcopy and Cervical Pathology