VIA procedure Ė Examination before application of acetic acid Ė Abnormal findings on speculum examination Ė Leukoplakia
Leukoplakia is a well-demarcated white area visible on the cervix even before application of acetic acid. Deposition of keratin (a type of protein with the consistency of wax) in the superficial layers of the cervical epithelium leads to the leukoplakic patches, which may often be raised from the surface of the cervix. Normal cervical squamous epithelium does not contain keratin. Leukoplakia can be idiopathic (i.e. of unknown cause), can be induced by chronic irritation (like in uterine prolapse), or may be due to HPV infection.
Rarely, leukoplakia may have an underlying high-grade CIN or even invasive cancer. Leukoplakia may be present within or outside the TZ. Leukoplakia located within the TZ and close to the SCJ is more likely to have a high-grade precancer or cancer hidden underneath the keratin layers. The presence of leukoplakia in the TZ should be considered as a positive VIA finding, and the woman should be referred for further assessment.
The next section describes cervical condyloma.