Revised November 2020
Vulvar Intraepithelial Neoplasia (VIN), is a precursor lesion in some cases:
- Usual type VIN (warty, basaloid and mixed)
- Differentiated VIN
- Not HPV-related
- Generally preceded by chronic inflammatory conditions of the vulva (lichen sclerosis, squamous hyperplasia)
In 2004, the International Society for the Study of Vulvovaginal Diseases (ISSVD) developed a new classification of VIN. The term VIN1 is no longer used, and VIN2 and VIN3 are now both called VIN.
VIN can be treated with wide local excision, and/or laser therapy. The use of topical imiquimod has also shown good response rates in women with usual type VIN.
There is no screening program for vulvar cancer. However, due to similar risk factors, women with a past history of HPV related cervical or vaginal cancer should have a careful inspection of their vulva as part of their regular follow-up. Women with lichen sclerosis, or with a past history of VIN should also have routine surveillance.
Vulvar cancer can be asymptomatic, but the majority of patients present with a vulvar lump or a vulvar ulcer. There is often pain associated with the lesion, along with a long-standing history of vulvar pruritis, bleeding or discharge. Most squamous cell carcinomas of the vulva occur on the labia majora, but the labia minora, clitoris, and perineum may also be primary sites. Advanced cases may present with an enlarged inguinofemoral node.
The diagnosis needs to be confirmed with a biopsy prior to definitive management. The biopsy should include underlying stroma in order to assess for the depth of invasion. An office wedge or Keyes punch biopsy is usually sufficient.
Preferably, the entirety of the lesion should not be excised in order to obtain a tissue diagnosis, as this can make it challenging to plan the definitive excision.
- Histological Classification:
- Squamous cell carcinoma
- Malignant Melanoma
- Verrucous carcinoma
- Pagets disease of the vulva
- Basal cell carcinoma
- Bartholin’s gland carcinoma