Treatment of Vulvar Intraepithelial Neoplasia — HSIL (Usual-Type VIN), HPV-Related, with Occult Invasion Ruled Out

This protocol addresses HSIL (usual-type VIN), the HPV-related form of vulvar intraepithelial neoplasia, in a patient who is not pregnant and not immunosuppressed, and in whom occult invasion has been definitively excluded.

Ruling out occult invasion is the key prerequisite in this scenario. Ablative or topical therapies are appropriate for HSIL (usual-type VIN) only after invasion has been excluded — this confirmation determines which management approaches can be offered.

Excision is the treatment of choice, though once invasion is excluded, anatomy-preserving alternatives — including ablative or topical strategies, alone or in combination with excision — may also be considered. Which option applies depends on lesion characteristics detailed in the full protocol.