Biopsy of a persistent exophytic area on the vulva of a 60 year old woman demonstrates a squamous epithelial lesion. No koilocytes are seen. The lesions show papillary projections composed of disordered, squamous epithelium with well differentiated cells. The basement membrane at the dermal-epidermal junction is focally disrupted by squamous cell groups extending deep into the dermis. Which of the following diagnoses is most accurate?
Condyloma acuminatum Extramammary Paget's disease Vulvar intraepithelial neoplasia Vulvar squamous cell carcinoma