Vulval cancer is rare and constitutes approximately 3% of gynaecological cancers worldwide. The incidence of vulval cancer has increased since the mid-1990s owing to the increased incidence in younger women, which has doubled over the past 30 years. Clinical trials in vulval cancer can be divided into two categories-trials in women with vulval cancer and, more recently, trials on the prevention of vulval cancer by preventing or treating human papillomavirus (HPV)-related vulval intraepithelial neoplasia (VIN). Numerous studies have tried to evaluate the role of neoadjuvant radiotherapy and/or chemotherapy in this disease to reduce the extent of surgery. Early studies involving the medical treatment of VIN with imiquimod, cidofovir and especially therapeutic vaccines appear promising in the prevention of vulval cancer. However, the greatest effect on preventing cancer is likely to arise as a result of vaccination programmes of the prophylactic HPV vaccines, assuming adequate uptake of the vaccine.

This chapter discusses premalignancy of the cervix, as this is the most common of the preinvasive conditions and the only one that is screened for on a population basis. Several large randomised studies have now been completed and published and they have shown that quadravalent and bivalent types of vaccine effectively increase specific immunoglobulin G, reduce or eliminate infection with type specific virus and effectively eliminate preinvasive disease related to the vaccinated subtypes. Genital human papillomaviruses (HPVs) are divided into higher-risk types and lower risk types depending on their association with malignancy. If a woman has VIN, the rest of the lower genital tract should be carefully examined, as there is an increased risk of intraepithelial neoplasia at other sites. Local treatment for cervical intraepithelial neoplasia (CIN) is highly effective. Vaginal and vulval intraepithelial neoplasias are much less common and appear to have less invasive potential than CIN.