striking increase in vulval intraepithelial neoplasia (VIN) since 1980 with the median age of presentation falling to the mid-30's
at least 2/3rds of these women smoke cigarettes
nearly 50% have PH of SIL/CIN
many of the younger women have HPV DNA on biopsy
clinical presentations
vulvar pruritus
vulval lump
warty vulvar lesion which may be unifocal or multifocal, flat, papular or in extensive plaques, pigmented, white or red
transit times from VIN III to invasion is less than 8yrs in nearly all studies, thus any gross lesion should be biopsied or referred to a vulvar specialist