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Diagnosis of Precancerous Vulvar Abnormalities

  Presented by Hope K. Haefner, MD and Abigail Lowther, MD

Release Date of Activity: June 21, 2013
Expiration Date of Activity for AMA PRA Credit: June 30, 2016
Estimated Time to Complete This Activity: 1 hour    

Authors and Reviewers Biosketches Coming Soon
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Course Summary
The awareness of and familiarity with precancerous abnormalities of the vulva is often lacking in healthcare providers, despite the fact that they routinely perform pelvic exams in which they examine vulvas. In addition, the incidence of vulvar intraepithelial neoplasia has been increasing over the past several decades due to multiple factors. Therefore, there is a clear need for further education about the diagnosis and management of the various conditions that can progress to potentially fatal cancers of the vulva.

This two part CME course will increase knowledge regarding the pathogenesis and clinical presentation, and particularly the appearance, of vulvar precancerous lesions. The participant will gain the ability to decide when and how to biopsy these lesions, and to understand the categorization of both HPV-related and non-HPV-related conditions, including the latest Lower Anogenital Squamous Terminology (LAST) nomenclature system. In the second part of the course, the participant will learn about the various management options for precancerous vulvar abnormalities and the potential risks and benefits of each one.

Is this educational activity right for me?
The Management and Diagnosis of Precancerous Vulvar Abnormalities and activity is designed for any healthcare provider who routinely examines external female genitalia, including obstetrician/gynecologists, primary care physicians, and advanced practice clinicians.

Course Competencies and Objectives
Upon completion of the course, participants will be able to do the following:

-have a proper index of suspicion for pre-malignant vulvar conditions based on the history and physical appearance of the lesion

-determine the appropriate time and location(s) for biopsy most likely to definitively rule out or rule in a pre-malignant vulvar condition

-explain the relationship between HPV and VIN to learners, including patients, and understand how to use patient history components relating to HPV to aid in decisions about when and where to biopsy

-explain the relationship between lichen sclerosus and HPV to learners, including patients, and understand the importance of treatment and close follow-up of patients with lichen sclerosus

-understand the relationship between cervical, vaginal and anal intraepithelial neoplasia and vulvar intraepithelial neoplasia, and know how to appropriately incorporate anoscopy into the care of women with VIN

-know the most recent ASCCP CAP LAST VIN pathology classification system, use it to guide management plans, and to facilitate communication among providers.

-appropriately treat and, when necessary, refer patients with vulvar pre-malignant conditions for more specialized care

ACCME Accreditation
The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

Continuing Medical Education (CME) Credit
The ASCCP designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Management of Conflicts of Interest and Contributed Funds
As an accredited provider of CME credit, ASCCP is required to comply with the ACCME's Standards for Commercial Support and has implemented a management process to ensure that anyone who is in a position to affect the content of the educational activity (e.g., faculty, planners, etc.) has disclosed to us all relevant financial relationships with any commercial interest and has ensured that those relationships do not influence presentation materials. All faculty have agreed to base their presentations on best available evidence. ASCCP discloses to learners any financial relationship(s) to healthcare-related commercial interests existing within the past 12 months to include the following information: 1) the name of the individual; 2) the name of the commercial interest; and, 3) the nature of the relationship the person has with each commercial interest. Slides and slide notes are reviewed for possible bias prior to the activity's release by the Accreditation Committee and peer-reviewers, and potential conflicts of interest are resolved prior to the live presentation. Any discussion of off-label use of products is noted when appropriate, as is discussion of any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Disclosures of these commitments and/or relationships are published in these lecture materials and provided prior to the start of the activity, so the learners may formulate their own judgments regarding the presentation(s). Under ASCCP policy, anyone declining either to disclose or amend material to eliminate potential bias identified by the Accreditation Committee will be replaced.

Author, Reviewers, and Planners' Disclosure Information
The following are all reported disclosures of interest or potential conflicts from the 12 months preceding this activity:

J. Thomas Cox, MD (Project Editor) - serves on the Data and Safety Monitoring Board for Merck & Co and receives a fee for his service. He is also a scientific advisory board member for Gen-Probe and an advisory board member for Abbott, for both of which he receives an honorarium.

Hope Haefner (Author) – serves on the Advisory Board for Merck & Co, Inc.

Those reporting no financial relationships or conflict of interest to disclose:
Abigail Lowther, MD (Author)
L. Stewart Massad, MD (Accreditation Committee /CME Reviewer/Planner)
Herschel W. Lawson, MD (Accreditation Committee Chair)
Alan G. Waxman, MD (CME Reviewer)
Chanise Reese-Queen (ASCCP Education and Meetings Director, Planner)
Carol Noonan (ASCCP Assistant Course Administrator, Planner)

For all CME certificate inquiries, please email or by mail at the ASCCP National Office, 1530 Tilco Drive, Suite C, Frederick, MD 21704 or by phone at 301-733-3640

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