Akbari A, Pinto A, Amemiya Y, et al. - Recently the term differentiated exophytic vulvar intraepithelial lesion (DEVIL) has been proposed for verruciform proliferations of the vulva unrelated to HPV infection, which harbor recurrent PIK3CA mutations. Researchers here sought to determine if DEVIL is related to verrucous carcinoma, a neoplasm with persistence and local recurrence but nil risk of distant spread. Among specimens identified using the words “verruciform” and “verrucous”, DEVIL was diagnosed based on the presence of verruciform acanthosis, hyper and/or parakeratosis, hypogranulosis, cytoplasmic pallor, and bland nuclei and verrucous carcinoma was diagnosed based on the presence of discontinuous, bulbous, puzzle-like nests in the stroma, in addition. They performed a targeted next-generation sequencing using a custom 11-gene panel. Inclusion of 18 specimens corresponding to 10 patients with DEVIL and/or verrucous carcinoma was done. Wild-type 53 staining was evident and pathogenic TP53 mutations was lacking in all cases. DEVIL is identified to be a rare form of squamous proliferation with prevalence of PIK3CA and HRAS mutations. It showed temporal correlation with verrucous carcinoma and the two had shared mutational profile in some patients; this indicates that DEVIL is a precursor of verrucous carcinoma. Furthermore, DEVIL and verrucous carcinoma seemed representing a spectrum of the same entity given their morphologic and molecular overlap and the nil risk of verrucous carcinoma for distant spread.