. Brown, ne retrouvent cependant pas de cancer invasif chez leurs 33 patientes traitées par exérèse chirurgicale [72] Dans la méta-analyse de Van Seters et al., le taux de cancer vulvaire méconnu à la biopsie initiale est de 3.2%. La moyenne d'âge est de 52 ans (21 à 87 ans) [17]. En fonction des données de la littérature, le taux de cancer invasif de découverte fortuite à l'examen, p.617172

. Tous-traitements-confondus, le risque de récidive au-delà de un an était dans notre étude de 21.6%, le risque d'évolution vers un carcinome épidermoïde de 3, 9%. Selon Van Seters et al le potentiel invasif des VIN classiques est de 3.3% (n=108/3322) après traitement

B. 1. Paniel, B. Truc, J. De-margerie, and V. , Vulvo-perineal surgery], J Gynecol Obstet Biol Reprod, vol.13, issue.1, pp.91-100, 1984.

H. Howe, P. Wingo, and M. Thun, Annual report to the nation on the status of cancer featuring cancers with recent increasing trends Cancer incidence in five continents. Volume VIII Review of squamous premalignant vulvar lesions, J Natl Cancer Inst IARC Sci Publ Crit Rev Oncol Hematol, vol.3, issue.42, pp.93824-8421, 1973.

P. Judson, E. Habermann, and N. Baxter, Trends in the Incidence of Invasive and In Situ Vulvar Carcinoma, Obstetrics & Gynecology, vol.107, issue.5, pp.1071018-1022, 2006.
DOI : 10.1097/01.AOG.0000210268.57527.a1

G. Akerman, C. Dussour, and B. Haddad, Epidemiology of vulvar intra-epithelial neoplasias

D. Vuyst, H. Clifford, G. Nascimento, and M. , Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: A meta-analysis, International Journal of Cancer, vol.50, issue.7, pp.1241626-1636, 2009.
DOI : 10.1155/2007/159137

C. Renaud-vilmer, B. Cavelier-balloy, and T. Petit, Vulvar intra-epithelial neoplasias], Ann Dermatol Venereol, pp.132-138, 2005.

M. Preti, M. Van-seters, and M. Sideri, Squamous Vulvar Intraepithelial Neoplasia, Clinical Obstetrics and Gynecology, vol.48, issue.4, pp.845-861, 2005.
DOI : 10.1097/01.grf.0000181738.37911.03

B. Burdick, Clarifying theReport of the ISSVD Terminology Committee, J Reprod Med, vol.1988, issue.7, pp.3397-98

M. Sideri, R. Jones, and E. Wilkinson, Squamous Vulvar Intraepithelial Neoplasia: 2004 Modified Terminology, ISSVD Vulvar Oncology Subcommittee, Obstetrical & Gynecological Survey, vol.61, issue.3, pp.50807-810, 2005.
DOI : 10.1097/01.ogx.0000201921.69949.10

C. Bergeron, New histological terminology of vulvar intraepithelial neoplasia], Gynecol Obstet Fertil, vol.200836, issue.1, pp.74-78

R. Jones and D. Rowan, Spontaneous regression of vulvar intraepithelial neoplasia 2-3, Obstet Gynecol, issue.3, pp.96470-472, 2000.

E. Joura, A. Losch, and M. Haider-angeler, Trends in vulvar neoplasia Increasing incidence of vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva in young women, J Reprod Med, issue.8, pp.45613-615, 2000.

F. Medeiros, A. Nascimento, C. Crum, M. Van-beurden, and A. De-craen, Early Vulvar Squamous Neoplasia, Advances in Anatomic Pathology, vol.12, issue.1, pp.20-2697645, 2005.
DOI : 10.1097/01.pqp.0000151268.72556.f3

I. Bruchim, W. Gotlieb, and S. Mahmud, HPV-related vulvar intraepithelial neoplasia: Outcome of different management modalities, International Journal of Gynecology & Obstetrics, vol.16, issue.1, pp.9923-9950, 2007.
DOI : 10.1111/j.1525-1438.2006.00375.x

O. Mcnally, N. Mulvany, and R. Pagano, VIN 3: a clinicopathologic review, International Journal of Gynecological Cancer, vol.12, issue.5, pp.12490-495, 2002.
DOI : 10.1046/j.1525-1438.2002.01140.x

I. Etienney and P. Bauer, Prevention of anal lesions due to human papillomavirus at the time of screening and vaccination], Gastroenterol Clin Biol, issue.11, pp.32942-945, 2008.

F. Sabban, P. Collinet, and M. Cosson, Fluorescence imaging technique: diagnostic and therapeutic interest in gynecology], J Gynecol Obstet Biol Reprod, issue.8, pp.33734-738, 2004.

K. Akoel, J. Welfel, and L. Gottwald, Photodynamic diagnosis of vulvar precancerous conditions and invasive cancers using 5-aminolevulinic acid, Ginekol Pol, issue.9, pp.74662-665, 2003.

E. Joura and . Epidemiology, Epidemiology, diagnosis and treatment of vulvar intraepithelial neoplasia, Current Opinion in Obstetrics and Gynecology, vol.14, issue.1, pp.39-43
DOI : 10.1097/00001703-200202000-00007

P. Deruelle, R. Deruelle-khazaal, and P. Collinet, Clinical study and prognosis of 56 cases of vulvar intraepithelial neoplasia], Gynecol Obstet Fertil, issue.10, pp.33755-761, 2005.

R. Jones, J. Baranyai, and S. Stables, Trends in Squamous Cell Carcinoma of the Vulva: The Influence of Vulvar Intraepithelial Neoplasia, Obstetrics & Gynecology, vol.90, issue.3, pp.90448-452, 1997.
DOI : 10.1016/S0029-7844(97)00298-6

R. Jones, D. Rowan, and A. Stewart, Vulvar Intraepithelial Neoplasia, Obstetrics & Gynecology, vol.106, issue.6, pp.1061319-1326, 2005.
DOI : 10.1097/01.AOG.0000187301.76283.7f

G. Ho, R. Bierman, and L. Beardsley, Natural History of Cervicovaginal Papillomavirus Infection in Young Women, New England Journal of Medicine, vol.338, issue.7, pp.338423-428, 1998.
DOI : 10.1056/NEJM199802123380703

R. Kaufman, S. De-sanjose, M. Diaz, and X. Castellsague, Intraepithelial Neoplasia of the Vulva, Gynecologic Oncology, vol.56, issue.1, pp.8-217453, 1995.
DOI : 10.1006/gyno.1995.1003

A. Burchell, R. Winer, and S. De-sanjose, Chapter 6: Epidemiology and transmission dynamics of genital HPV infection, Vaccine, vol.24, issue.S3, pp.52-61, 2006.
DOI : 10.1016/j.vaccine.2006.05.031

J. Baseman and L. Koutsky, The epidemiology of human papillomavirus infections, Journal of Clinical Virology, vol.32, issue.1, pp.16-24, 2005.
DOI : 10.1016/j.jcv.2004.12.008

E. Baulon, A. Vautravers, and B. Rodriguez, Imiquimod and immune response modifiers in gynaecology], Gynecol Obstet Fertil, issue.2, pp.35149-157, 2007.

H. Richardson, G. Kelsall, and P. Tellier, The natural history of type-specific human papillomavirus infections in female university students, Cancer Epidemiol Biomarkers Prev, issue.6, pp.12485-490, 2003.

C. Mougin, I. Bourgault-villada, and P. Coursaget, [HPV immunization for the prevention of cervical cancer], Presse Med, issue.12, pp.381750-1768, 2009.
URL : https://hal.archives-ouvertes.fr/hal-00484613

M. Hampl, H. Sarajuuri, and N. Wentzensen, Effect of Human Papillomavirus Vaccines on Vulvar, Vaginal, and Anal Intraepithelial Lesions and Vulvar Cancer, Obstetrics & Gynecology, vol.108, issue.6, pp.1361-1368, 2006.
DOI : 10.1097/01.AOG.0000245786.86267.80

S. Garland, R. Insinga, and H. Sings, Human Papillomavirus Infections and Vulvar Disease Development, Cancer Epidemiology Biomarkers & Prevention, vol.18, issue.6, pp.181777-1784, 2009.
DOI : 10.1158/1055-9965.EPI-09-0067

URL : http://cebp.aacrjournals.org/content/cebp/18/6/1777.full.pdf

L. Kuhn, X. Sun, T. Wright, and J. , Human immunodeficiency virus infection and female lower genital tract malignancy, Current Opinion in Obstetrics and Gynaecology, vol.11, issue.1, pp.35-39, 1999.
DOI : 10.1097/00001703-199901000-00007

T. Wade, A. Kopf, and A. Ackerman, Bowenoid papulosis of the penis, Cancer, vol.36, issue.4, pp.1890-1903
DOI : 10.3181/00379727-32-7770P

A. Menguellet, S. Collinet, P. Debarge, and V. , Management of multicentric lesions of the lower genital tract, European Journal of Obstetrics & Gynecology and Reproductive Biology, vol.132, issue.1, pp.116-120, 2007.
DOI : 10.1016/j.ejogrb.2006.04.011

F. Plantier and M. Moyal-barracco, Comprendre les n??oplasies intra??pith??liales vulvaires, Annales de Dermatologie et de V??n??r??ologie, vol.136, issue.2, pp.145-151, 2009.
DOI : 10.1016/j.annder.2008.12.005

P. Hillemanns, X. Wang, and S. Staehle, Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO2 laser vaporization, photodynamic therapy, excision and vulvectomy, Gynecologic Oncology, vol.100, issue.2, pp.271-2753581465, 2006.
DOI : 10.1016/j.ygyno.2005.08.012

M. Leibowitch, S. Neill, and M. Pelisse, The epithelial changes associated with squamous cell carcinoma of the vulva: a review of the clinical, histological and viral findings in 78 women, Br J Obstet Gynaecol, issue.12, pp.971135-1139, 1990.

J. Carlson, A. R. Malfetano, and J. , Vulvar lichen sclerosus and squamous cell carcinoma: A cohort, case control, and investigational study with historical perspective; implications for chronic inflammation and sclerosis in the development of neoplasia, al. New nomenclature for vulvar disease: International Society for the Study of Vulvar Disease, pp.29932-94820495, 1989.
DOI : 10.1016/S0046-8177(98)90198-8

G. Fischer, B. Spurrett, A. Fischer, A. Leibovitz, V. Kaplun et al., The chronically symptomatic vulva: aetiology and management Vulvovaginal examinations in elderly nursing home women residents, Br J Obstet Gynaecol Arch Gerontol Geriatr, vol.48, issue.101, pp.102773-779311, 1995.

A. Goldstein, S. Marinoff, and K. Christopher, Prevalence of vulvar lichen sclerosus in a general gynecology practice, J Reprod Med, issue.7, pp.50477-480, 2005.

R. Jones, J. Scurry, and S. Neill, Guidelines for the follow-up of women with vulvar lichen sclerosus in specialist clinics, American Journal of Obstetrics and Gynecology, vol.198, issue.5, pp.198496-491, 2008.
DOI : 10.1016/j.ajog.2007.05.031

S. Neill, F. Tatnall, and N. Cox, Guidelines for the management of lichen sclerosus, British Journal of Dermatology, vol.38, issue.4, pp.640-649, 2002.
DOI : 10.1046/j.1365-2133.1999.3029a.x

B. Yang and W. Hart, Vulvar Intraepithelial Neoplasia of the Simplex (Differentiated) Type, The American Journal of Surgical Pathology, vol.24, issue.3, pp.24429-441, 2000.
DOI : 10.1097/00000478-200003000-00013

A. Nascimento, S. Granter, and A. Cviko, Vulvar Acanthosis With Altered Differentiation, The American Journal of Surgical Pathology, vol.28, issue.5, pp.28638-643, 2004.
DOI : 10.1097/00000478-200405000-00012

F. Collier, N??oplasies vulvaires intra??pith??liales (VIN)??: v??cu des patientes, Gyn??cologie Obst??trique & Fertilit??, vol.36, issue.3, pp.306-310, 2008.
DOI : 10.1016/j.gyobfe.2007.12.014

C. Jayne and R. Kaufman, Treatment of vulvar intraepithelial neoplasia 2/3 with imiquimod, J Reprod Med, issue.5, pp.47395-398, 2002.

T. Le, W. Hicks, and C. Menard, Preliminary Results of 5% Imiquimod Cream in the Primary Treatment of Vulva Intraepithelial Neoplasia Grade 2/3, Journal of Lower Genital Tract Disease, vol.10, issue.3, pp.194377-380, 2006.
DOI : 10.1097/00128360-200607000-00097

T. Le, C. Menard, and W. Hicks-boucher, Final results of a phase 2 study using continuous 5% Imiquimod cream application in the primary treatment of high-grade vulva intraepithelial neoplasia, Gynecologic Oncology, vol.106, issue.3, pp.106579-584, 2007.
DOI : 10.1016/j.ygyno.2007.05.019

R. Todd, I. Etherington, and D. Luesley, The Effects of 5% Imiquimod Cream on High-Grade Vulval Intraepithelial Neoplasia, Gynecologic Oncology, vol.85, issue.1, pp.8567-70, 2002.
DOI : 10.1006/gyno.2001.6539

J. Wendling, P. Saiag, and S. Berville-levy, Treatment of Undifferentiated Vulvar Intraepithelial Neoplasia With 5% Imiquimod Cream, Archives of Dermatology, vol.140, issue.10, pp.1401220-1224, 2004.
DOI : 10.1001/archderm.140.10.1220

O. Mathiesen, S. Buus, and M. Cramers, Topical imiquimod can reverse vulvar intraepithelial neoplasia: A randomised, double-blinded study, Gynecologic Oncology, vol.107, issue.2, pp.219-222, 2007.
DOI : 10.1016/j.ygyno.2007.06.003

K. Mcfadden, L. Sharp, and M. Cruickshank, The prospective management of women with newly diagnosed vulval intraepithelial neoplasia: Clinical outcome and quality of life, Journal of Obstetrics and Gynaecology, vol.67, issue.8, pp.29749-753, 2009.
DOI : 10.1111/j.1600-0447.1983.tb09716.x

C. Iavazzo, E. Pitsouni, and S. Athanasiou, Imiquimod for treatment of vulvar and vaginal intraepithelial neoplasia Imiquimod in the treatment of multifocal vulvar intraepithelial neoplasia 2/3. Results of a pilot study, Int J Gynaecol Obstet J Reprod Med, vol.101, issue.19, pp.47701-705, 2002.

G. Davis, J. Wentworth, and R. J. , Self-administered topical imiquimod treatment of vulvar intraepithelial neoplasia. A report of four cases, J Reprod Med, issue.8, pp.45619-623, 2000.

C. Diaz-arrastia, I. Arany, and S. Robazetti, Clinical and molecular responses in high-grade intraepithelial neoplasia treated with topical imiquimod 5%, Clin Cancer Res, issue.10, pp.73031-3033, 2001.

C. Marchitelli, G. Secco, and M. Perrotta, Treatment of bowenoid and basaloid vulvar intraepithelial neoplasia 2/3 with imiquimod 5% cream, J Reprod Med, issue.11, pp.49876-882, 2004.

D. Haidopoulos, E. Diakomanolis, and A. Rodolakis, Can local application of imiquimod cream be an alternative mode of therapy for patients with high-grade intraepithelial lesions of the vagina?, International Journal of Gynecological Cancer, vol.15, issue.5, pp.15898-902, 2005.
DOI : 10.1111/j.1525-1438.2005.00152.x

U. Winters, S. Daayana, and J. Lear, Clinical and Immunologic Results of a Phase II Trial of Sequential Imiquimod and Photodynamic Therapy for Vulval Intraepithelial Neoplasia, Clinical Cancer Research, vol.14, issue.16, pp.145292-5299, 2008.
DOI : 10.1158/1078-0432.CCR-07-4760

P. Shatz, C. Bergeron, and E. Wilkinson, Vulvar intraepithelial neoplasia and skin appendage involvement, Obstet Gynecol, issue.5, pp.74769-774, 1989.

M. Sideri, L. Spinaci, and N. Spolti, Evaluation of CO(2) laser excision or vaporization for the treatment of vulvar intraepithelial neoplasia, Gynecol Oncol, issue.2, pp.75277-281, 1999.

J. Brown, B. Goldstein, and M. Rettenmaier, Laser Ablation of Surgical Margins After Excisional Partial Vulvectomy for VIN, Obstetrical & Gynecological Survey, vol.60, issue.9, pp.50345-350, 2005.
DOI : 10.1097/01.ogx.0000175797.73644.10

C. Penna, M. Fallani, and M. Fambrini, CO2 laser surgery for vulvar intraepithelial neoplasia. Excisional, destructive and combined techniques, J Reprod Med, issue.11, pp.47913-918, 2002.

V. Wright and E. Davies, Laser surgery for vulvar intraepithelial neoplasia: principles and results

T. Dougherty, C. Gomer, and B. Henderson, Photodynamic therapy, J Natl Cancer Inst, issue.12, pp.90889-905, 1998.

M. Ascencio, P. Collinet, and M. Cosson, The place of photodynamic therapy in gynecology

M. Fehr, R. Hornung, and A. Degen, Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid, Lasers in Surgery and Medicine, vol.1, issue.2, pp.273-27999652, 2002.
DOI : 10.1016/S0002-9378(96)70260-0

H. Lin, E. Huang, and H. Chang, Therapeutic Effect of Topical Applications of Trichloroacetic Acid for Vaginal Intraepithelial Neoplasia after Hysterectomy, Japanese Journal of Clinical Oncology, vol.35, issue.11, pp.35651-654, 2005.
DOI : 10.1016/S0002-9378(99)70379-0

C. Vilmer, S. Havard, and B. Cavelier-balloy, Failure of isotretinoin and interferon-alpha combination therapy for HPV-linked severe vulvar dysplasia. A report of two cases, J Reprod Med, issue.8, pp.43693-695, 1998.

R. Naik, S. Nixon, and A. Lopes, A randomized phase II trial of indole-3-carbinol in the treatment of vulvar intraepithelial neoplasia, International Journal of Gynecological Cancer, vol.16, issue.2, pp.16786-790, 2006.
DOI : 10.1111/j.1525-1438.2006.00386.x

F. Pelletier, C. Drobacheff-thiebaut, and F. Aubin, Effects of imiquimod on latent human papillomavirus anal infection in HIV-infected patients], Ann Dermatol Venereol, issue.11, pp.131947-951, 2004.

R. Maw, Treatment of external genital warts with 5% imiquimod cream during pregnancy: a case report, BJOG: An International Journal of Obstetrics and Gynaecology, vol.111, issue.12, p.1111475
DOI : 10.1258/0956462011923723

A. Ahr, A. Rody, and S. Kissler, Risk factors for recurrence of vulvar intraepithelial neoplasia III (VIN III)], Zentralbl Gynakol, issue.6, pp.128347-351, 2006.

C. Desimone, M. Crisp, and F. Ueland, Concordance of Gross Surgical and Final Fixed Margins in Vulvar Intraepithelial Neoplasia 3 and Vulvar Cancer, Obstetrical & Gynecological Survey, vol.61, issue.12, pp.51617-620, 2006.
DOI : 10.1097/01.ogx.0000248800.62038.4e

R. Rouzier, B. Haddad, and D. Atallah, Surgery for Vulvar Cancer, Clinical Obstetrics and Gynecology, vol.48, issue.4, pp.869-878, 2005.
DOI : 10.1097/01.grf.0000179667.76068.7f

L. Argenta and M. Morykwas, Vacuum-assisted closure: a new method for wound control and treatment: clinical experience, Ann Plast Surg, vol.577, issue.6, pp.38563-576, 1997.

Y. Durmishi, P. Gervaz, and L. Buhler, Vacuum-assisted abdominal closure: its role in the treatment of complex abdominal and perineal wounds Experience in 48 patients] Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions, J Chir (Paris) N Engl J Med, vol.2007, issue.89, pp.144209-2133561915, 2007.

J. Paavonen, D. Jenkins, and F. Bosch, Efficacy of a prophylactic adjuvanted bivalent L1 viruslike-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial, Lancet, issue.9580, pp.3692161-2170, 2007.

B. Andersen and N. Hacker, Psychosexual adjustment after vulvar surgery, Obstet Gynecol, vol.62, issue.4, pp.457-462, 1983.

R. Rosen, C. Brown, and J. Heiman, The Female Sexual Function Index (FSFI): A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function, Journal of Sex & Marital Therapy, vol.41, issue.2, pp.191-20832255, 2000.
DOI : 10.1007/BF01541816

B. Thuesen, B. Andreasson, and J. Bock, Sexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasia, Acta Obstetricia et Gynecologica Scandinavica, vol.71, issue.2, pp.71126-128, 1992.
DOI : 10.3109/00016349209007969

B. Andreasson, I. Moth, and S. Jensen, Sexual Function and Somatopsychic Reactions in Vulvectomy-Operated Women and their Partners, Acta Obstetricia et Gynecologica Scandinavica, vol.65, issue.1, pp.657-667, 1986.
DOI : 10.3109/00016348609158221

W. Schultz, W. Van-de-wiel, H. Bouma, and J. , Psychosexual functioning after the treatment of cancer of the vulva: A longitudinal study, Cancer, vol.9, issue.2, pp.66402-407, 1990.
DOI : 10.1097/00006842-197611000-00003

G. Zhang, L. Wu, and B. Li, Clinical analysis of 35 cases of vulvar intraepithelial neoplasia grade III], Zhonghua Fu Chan Ke Za Zhi, issue.3, pp.44163-166, 2009.

S. Polterauer, C. Dressler, A. Grimm, and C. , Accuracy of Preoperative Vulva Biopsy and the Outcome of Surgery in Vulvar Intraepithelial Neoplasia 2 and 3, International Journal of Gynecological Pathology, vol.28, issue.6, pp.28559-562, 2009.
DOI : 10.1097/PGP.0b013e3181a934d4

S. Modesitt, A. Waters, and L. Walton, Vulvar intraepithelial neoplasia III: occult cancer and the impact of margin status on recurrence, Obstet Gynecol, issue.6, pp.92962-966, 1998.

A. Rodolakis, E. Diakomanolis, and G. Vlachos, Vulvar intraepithelial neoplasia (VIN)-diagnostic and therapeutic challenges, Eur J Gynaecol Oncol, pp.24-27, 2003.

P. Hillemanns, M. Untch, and C. Dannecker, Photodynamic therapy of vulvar intraepithelial neoplasia using 5-aminolevulinic acid, International Journal of Cancer, vol.192, issue.5, pp.85649-653, 2000.
DOI : 10.1159/000246376

P. Martin-hirsch, C. Whitehurst, and C. Buckley, Photodynamic treatment for lower genital tract intraepithelial neoplasia, The Lancet, vol.351, issue.9113, p.3511403, 1998.
DOI : 10.1016/S0140-6736(98)24019-0

P. Soergel, M. Loning, and I. Staboulidou, Photodynamic Diagnosis and Therapy in Gynecology, Journal of Environmental Pathology, Toxicology and Oncology, vol.27, issue.4, pp.307-320, 2008.
DOI : 10.1615/JEnvironPatholToxicolOncol.v27.i4.80

F. Goffin, M. Mayrand, and P. Gauthier, High-risk human papillomavirus infection of the genital tract of women with a previous history or current high-grade vulvar intraepithelial neoplasia, Journal of Medical Virology, vol.13, issue.6, pp.78814-819, 2006.
DOI : 10.1097/00001703-199602000-00014

S. Vaccarella, R. Herrero, and P. Snijders, Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys, International Journal of Epidemiology, vol.347, issue.9006
DOI : 10.1016/S0140-6736(96)91417-8

L. Villa, R. Costa, and C. Petta, High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up, British Journal of Cancer, vol.157, issue.11, pp.951459-1466, 2006.
DOI : 10.1093/aje/kwf180