Pathology of the vulva

An understanding of diseases of the vulva and their pathology has been made more difficult in the past by the use of many different, and often confusing, terminologies. The increasing body of knowledge on the pathogenesis and natural history of vulval diseases has necessitated the development of new classifications and terminologies that simplify many of the old ideas and bring vulval pathology into line with the pathology of the lower female genital tract as a whole. As these diseases become increasingly recognized and, especially in the case of neoplastic lesions, identified at earlier stages, accurate pathologic evaluation will greatly influence management. This is especially critical as more conservative surgical management gains increasing acceptance for early-stage malignancies. With increasing and appropriate use of biopsies to confirm any clinical impression, it is imperative that clinicians and pathologists use similar terminologies to describe vulval diseases, and that they understand the implications of these diagnoses. Where necessary, pathologists must also document accurately the extent of vulval neoplasia, so that appropriate decisions regarding patient management can be made. This paper discusses some of the recent trends in the literature on vulvar pathology. It is not intended to be a review of all disease entities.