Clinical presentation, management strategies, and recurrence rates in vulvar intraepithelial neoplasia (VIN) globally: A systematic review.

Abstract

e17649 Background: Vulvar intraepithelial neoplasia (VIN) is a premalignant condition that lacks FDA-approved therapies or consensus management guidelines. This systematic review synthesizes global evidence on the presentation and management of VIN, with particular attention to variation in reporting, treatment strategies, and outcomes across surgical and nonsurgical approaches. Methods: The authors systematically searched global databases for articles related to VIN clinical presentation and management in accordance with PRISMA guidelines. Included studies had to have at least one treatment intervention and report on at least one of the following outcomes: clinical presentation, treatment modalities, recurrence rates, or progression to vulvar carcinoma. Only peer-reviewed articles published in English between 2000-2024 were included. Results: Among 3,650 publications, 58 met inclusion criteria. Studies (66%) were primarily conducted in Europe, with none from Africa. Sixteen studies (27.6%) included patients with HIV. Across studies, mean/median ages were typically in 40s-50s, with studies of immunocompromised cohorts skewing younger (min: 29 years) and those of differentiated VIN (dVIN) skewing older (max: 71 years). Sixteen studies (27.6%) evaluated exclusively usual-type VIN (uVIN) cohorts, while 4 (6.9%) evaluated exclusively dVIN cohorts. Treatment arms with at least one outcome datapoint (response, recurrence, progression) were included in our analysis (n=44 surgical arms, n=31 nonsurgical arms). Among the included studies, 44 evaluated surgical interventions and 31 evaluated nonsurgical therapies. Imiquimod was the most frequently studied nonsurgical treatment (n=17). Among studies reporting response outcomes, complete response rates ranged from approximately 45-100% across surgical modalities and 6-94% across nonsurgical modalities. Recurrence following treatment for VIN was common, with reported rates ranging from approximately 6-70%, most commonly between 20% and 50% for surgical and nonsurgical treatments. Where reported, median time to first recurrence ranged from ~7 to 42 months. At least one progression to vulvar cancer was reported in 15/44 (34.1%) surgical treatment arms and 8/31 (25.8%) nonsurgical arms. Conclusions: Management of VIN is highly variable, with surgical approaches predominating despite heterogeneous outcome reporting. Inconsistent clinical characterization and limited reporting of progression to cancer limit comparative evaluation of treatment strategies. Additionally, populations disproportionately affected by vulvar cancer, including those with HIV and in resource-limited settings, remain underrepresented. Standardized reporting and broader inclusion are needed to advance evidence-based VIN management.