Common causes of female private part (external skin) diseases -How to classify such diseases?

Vulvar Intraepithelial Disease.

Benign Epithelial Lesions of Vulva.

Basically disorders of growth and differentiation of epithelium of vulva. Previous terminology were 1) leukoplakia,b) Lichen sclerosis et atrophicus c) primary atrophy, d) sclerotic dermatosis e) atrophic vulvitis f) hyperplastic vulvitis g) Kraurosis vulvae.

A) First renaming was DYSTROPHY  ::-Jeffcoate’s( 1966) definition as VULVAR  DYSTROPHY   and his terminology is that all following lesions of low grade malignancies should be  designated as - All the following  age old  seven types of terminology e.g. a) leukoplakia,b) Lichen sclerosis et atrophicus c) primary atrophy, d) sclerotic dermatosis e) atrophic vulvitis f) hyperplastic vulvitis g) Kraurosis vulvae. Jeffcoate’s (1966) suggested that all such diseases be renamed as chronic Vulvar dystrophy.

B) SECOND  renaming was by International Society for study of Vulvar diseases”(ISSVD) : which insisted that the Jeffcoate’s term of Dystrophy be disregarded and all such epithelial diseases be renamed as ( depending on biopsy) “Nonneoplastic Epithelial Disorders of Skin and Mucosa” ( but  where cells in biopsy exhibit atypia are straightway classified under the heading  of VIN and not as Nonneoplastic disease). Therefore  to define such lesions as Nonneoplastic one has to perform biopsy on all such cases .

Now, the present terminology of benign lesions but not VIN Site of biopsy may be choosen by magnifying glass. Fortunately, the malig. Potential of all such lesions are very less but lesions which exhibit hyperplasia is at risk of developing VIN (Lichen Sclerosis is at highest risk of progression to Neoplastic lesions but may not be cancer.).

What is the different   biopsy features of Vulvar Intraepithelial Diseases?

A)Non-noeplastic  Epithelial Lesions of Vulva(no cellular atypia/ abnormal cell proliferation) as seen in biopsy

i)                 Lichen sclerosis (Lichen sclerosis et atrophicus).

ii)             Squamous hyperplasia (formerly known as hyperplastic dystrophy).

iii)          Other dermatosis.

B)   Mixed Nonneoplastic and Neoplastic Epithelial disorders of Vulva.

C)  Intraepithelial Neoplastic Lesions of Vulva (VIN 1/2/3 --those which exhibit cellular atypia).

i)                 Squamous Cellular atypia- VIN 1/2/3.

ii)             Nonsquamous intraepithelial Cellular atypia(Paget)

D)            Invasive cancers of  Vulva

In case of VIN(Dysplasia 1/2/3) :- In cases of  VIN(Vulvar intraepithelial neoplasia) lesions there is varying degree of cellular immaturity, nuclear abnormality, maturation disturbances and mitotic activities, cellular disorganization and formation of too many  immature cells .