ASCCP - Practice Recommendations - Practice Management Materials

PRACTICE RECOMMENDATIONS: Practice Management Materials

• Vulva • Vagina • Cervix • Anus

VULVA: HUMAN PAPILLOMAVIRUS INFECTIONS & VULVAR INTRAEPITHELIAL NEOPLASIA

HPV:	• Introduction	• Definition	• Diagnosis	• Treatment	• References
VIN:	• Introduction	• Definition	• Diagnosis	• Treatment	• References
	• Cases/Examples

HPV DIAGNOSIS
Visualization/Vulvar Colposcopy
Diagnosis of external genital HPV lesions is not always straight-forward. Normal papillary tissue in the vestibule of the female (microglandular papillomatosis) may be confused with HPV disease. Accurate diagnosis of these papillations in the female can usually be made on the basis of a single base for each projection in microglandular papillomatosis. HPV typically has multiple projections coming off a single base.

The vulva is optimally visualized after acetic acid application and the use of a vulvoscope. Many use a colposcope to magnify the vulva, but it is expensive and time consuming. The vulva can be easily visualized using a hand held magnifying lens. Biopsy and pathological examination should be considered in the following situations:

Lesions are surrounded by either thickened skin or color changes.
Lesions that are raised, red or pigmented.
Presumed genital warts that fail to respond to two or three office treatments.
Vulvar changes that do not respond to medical therapy, such as squamous cell hyperplasia and lichen sclerosus.
When any suspicion of neoplasia exists.