The known associations with oncogenic HPV DNA (types 16 and 18), p53 mutations, and pre-existing abnormal vulval skin conditions such as a thickened epidermis (squamous hyperplasia), lichen sclerosis, and intra-epithelial atypia, suggest a complex aetiology. Little prospective data exist to clarify the aetiology further. Women with these skin disorders should be kept under regular review by experienced clinicians and advised to report persistent symptoms or new skin changes that might herald malignant change.

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