Precancerous Squamous Lesions of the Vulva

The rate of vulvar cancer rates is rising, with high-grade squamous intraepithelial lesions, also known as vulvar intraepithelial neoplasia, and differentiated vulvar intraepithelial neoplasia representing key premalignant precursors to vulvar squamous cell carcinoma. Recent advances in classification and understanding of its causes-both human papillomavirus (HPV) associated and HPV independent-have significant implications for the diagnosis and management of these conditions. This review summarizes the evolving terminology, pathogenesis, clinical presentation, and current treatment strategies for vulvar squamous precancers, emphasizing the importance of distinguishing between the two major precancer subtypes to guide appropriate care.