RT Book, Section A1 Mayeaux, Jr., E.J. A2 Usatine, Richard P. A2 Smith, Mindy A. A2 Mayeaux, Jr., E.J. A2 Chumley, Heidi S. SR Print(0) ID 1164351648 T1 Vulvar Intraepithelial Neoplasia T2 The Color Atlas and Synopsis of Family Medicine, 3e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259862045 LK accessmedicine.mhmedical.com/content.aspx?aid=1164351648 RD 2024/03/28 AB A 63-year-old black woman presents with a "knot" on her labia majora (Figures 89-1 and 89-2). She is a smoker but is otherwise healthy. The lesion is occasionally pruritic but is generally asymptomatic. She found it approximately 6 months ago, and it has been slowly increasing in size. There is no significant family history of cancer. On physical exam, she is found to have exophytic condyloma acuminata around the introitus and a papule that the patient called a "knot." A 3-mm punch biopsy is performed and demonstrates vulvar intraepithelial neoplasia (VIN) III (high-grade squamous intraepithelial lesion [HSIL]). The patient is referred to gynecologic oncology.