Table 2. Significant univariate risk factors for clinically unrecognized invasive vulvar carcinoma detection in VHSIL (n=216).

Risk factor		Patients		p
		Total No.	No. (%) with invasive carcinoma
Patient age (tertiles, yr)				0.008*
	19–42	71	3 (4.2)
	43–62	74	8 (10.8)
	63–88	71	13 (18.3)
Year of treatment (quartiles)				0.029*
	1981–1994	51	2 (3.9)
	1995–2003	59	5 (8.5)
	2004–2008	54	9 (16.7)
	2009–2014	52	8 (15.4)
Vulvar thirds involved				0.020
	Upper third	29	5 (17.2)
	Middle third	25	2 (8.0)
	Lower third	60	6 (10.0)
	Two or three thirds	14	5 (35.7)
	Unknown	88	6 (6.8)
Lesion size (largest diameter, mm)				0.007
	<20	61	5 (8.2)
	≥20	74	15 (20.3)
	Unknown	81	4 (4.9)
Multifocality				0.022
	No	136	9 (6.6)
	Yes	76	14 (18.4)
	Unknown	4	1 (25.0)
Involvement of clitoris				0.002
	No	173	13 (7.5)
	Yes	41	11 (26.8)
	Unknown	2	0 (0.0)
Lesion appearance				0.022
	Macule	28	1 (3.6)
	Nodule	26	5 (19.2)
	Papule	54	7 (13.0)
	Plaque	49	10 (20.4)
	Ulcer	20	0 (0.0)
	Unknown	39	1 (2.6)
Reddish color				0.025
	No	128	10 (7.8)
	Yes	58	12 (20.7)
	Unknown	30	2 (6.7)

The following were not significantly (p<0.05) associated with the prevalence of clinically unrecognized invasive carcinoma detection: BMI (<25, ≥25, unknown); comorbidity (no, human immunodeficiency virus positivity, other); associated cervical and/or vaginal intraepithelial neoplasia; associated lichen sclerosus, squamous hyperplasia, and other dermatoses; symptoms; involvement of labia majora, of labia minora, of vestibule, of posterior fourchette, and of perineum; whitish color; hyperpigmentation; unless otherwise indicated, variables were coded as: no, yes, unknown.

BMI, body mass index; VHSIL, vulvar high-grade squamous intraepithelial lesion.

^*Test for trend.