Case Report: Successful treatment of verruciform acanthotic vulvar intraepithelial neoplasia with 5-aminolevulinic acid photodynamic therapy.

Abstract

Verruciform acanthotic vulvar intraepithelial neoplasia (vaVIN) is a rare, human papillomavirus (HPV)-independent, p53 wild-type intraepithelial precursor of the vulva, and standardized therapies for this disease are currently lacking. We report the case of a 68-year-old woman who presented with a 2-year history of multiple warty papules and vulvar pruritus and was diagnosed with vaVIN on the basis of histopathology (verruciform acanthosis with compact orthokeratosis, hypogranulosis, and superficial keratinocyte pallor with minimal cytologic atypia) and immunohistochemistry (HPV negativity, a p53 wild-type pattern, and non-block p16 expression) analyses. She underwent 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and achieved complete clinical remission, with no recurrence during the follow-up period. To our knowledge, reports on the use of photodynamic therapy for vaVIN are scarce. This case suggests that ALA-PDT may be a promising alternative treatment option for vaVIN.