Vulval intraepithelial neoplasia in immunosuppressed women: The management outcome and recommendations from a multi-disciplinary service

BackgroundHuman papillomavirus (HPV) dependent vulval intra-epithelial neoplasia (VIN) is a precursor to vulval squamous cell carcinoma (SCC) and an important global health concern. Immunosuppression increases the concurrence of VIN as well as multicentric HPV disease. A retrospective cohort study was designed to determine the burden of VIN in immunosuppressed women and extrapolate whether immunosuppression was a risk factor for poorer treatment outcomes.MethodAll biopsy proven women with VIN were reviewed over a 10-year period between 2013 and 2023. Patient and disease characteristics were collected and vulval lesions were mapped in quadrants using clinical photography. Treatment outcome including recurrence after first line treatment, progression to SCC or death due to disease were included.Results104 women were identified of whom 30% were immunosuppressed, with a higher burden of HPV disease including cervical (CIN) or anorectal (AIN) intraepithelial neoplasia and multifocal VIN. However, no difference in treatment outcome was found between the immunosuppressed and the control group. On multivariate analysis, having multifocal disease predicted worse treatment sequelae.ConclusionImmunosuppressed women need a multi-disciplinary group of specialists to manage their burden of HPV disease. Identifying multifocal and multicentric disease early is essential for improving treatment success.