Vulval intraepithelial neoplasia

Abstract

Vulval intraepithelial neoplasia (VIN) is characterized by disori-entation and loss of epithelial architecture extending through the full thickness of the epithelium but not penetrating the basement membrane. It is categorized into usual VIN (uVIN) and differentiated VIN (dVIN). uVIN often occurs in young women between 30–50 and is associated with smoking and human papillomavirus (HPV) in-fection. 3–4% of uVIN may progress to cancer. dVIN accounts for only 2–10% of all VINs and is more common in post- menopausal women. It is associated with squamous hyperplasia, lichen sclerosus and lichen simplex chronicus, and is considered as the precursor of most HPV- negative invasive keratinizing squamous cell carcinoma. It is found in up to 70–80% of adjacent cancer, and has a higher malignant potential than uVIN. Patients with VIN can be asympto-matic, or they may complain pruritus, pain, dysuria and dyspareu-nia. Lesions can be white, grey, pink or pigmented, in the forms of plaques, papules, nodules or even ulcers. While HPV vaccines can prevent uVIN, there is no effective screening tool for VIN. Diagnosis Actshas to be made by clinical examination and biopsy. It is also impor-tant to look for intraepithelial neoplasia in other sites like the cervix and vagina, particularly in the presence of uVIN. Treatment of uVIN includes imiquimod, laser therapy, and wide local excision. dVIN is mainly treated by surgical excision. Recurrence rate is between 10–50% and is more common for those with positive surgical margins. Because there is a risk of malignant progression especially in dVIN, long- term follow- up is essential.