Terminology | Age, frequency | Appearance of skin | Risk factors | Symptoms & Exam |
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VIN 1: no longer considered pre-cancerous (usually HPV 6 and 11) | ||||
VIN, USUAL TYPE (encompasses VIN 2 and 3) Former VIN warty type Former VIN baseloid type Former VIN mixed (warty and baseloid) type |
Younger, pre-menopausal women75% of VIN cases are in young women |
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VIN, DIFFERENTIATED TYPE (encompasses VIN 2 and 3) Former simplex type |
<5% of VIN cases are differentiated type and are usually in postmenopausal women |
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VIN, UNCLASSIFIED TYPE(rare) | BIOPSY suspicious lesions. |
TREATMENT OF VULVAR INTRAEPITHELIAL NEOPLASIA (2004 terminology)
See Atlas Topic or UpToDate for more information.
Treatment action | Topical/behavioral | Type of lesion | Procedure | Advantage/disadvantage/Notes |
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Comfort measures, general care | Sitz bath, gentle cleansing, topical petrolatum, avoidance of irritants or tight clothing, application of cool gel packs | When VIN, VAIN, CIN, or AIN are found, the patient needs to have a complete colposcopic evaluation of the vulva, vagina, cervix, and anus, including anoscopy. Treatment goal: Prevention of development of invasive cancer, relief of symptoms, preservation of normal anatomy and function. | If untreated, VIN may persist, progress, or resolve. Recurrence is common: 1/3 of women utilizing any treatment. | |
Wide local excision | VIN, most commonly differentiated type: unifocal | Wide local excision (knife, electrosurgery, CO2 laser) with a 1 cm margin and removal of the epidermis and a small section of dermis. | Allows for histopathological examination of the sample. | |
Laser ablation | VIN, most commonly usual type: multifocal or extensive | Laser vaporization treats the whole area, with depth to 1 mm (in hair-free areas) to 3 mm (in hair-bearing areas). | Must evaluate with colposcope and biopsy for cancer prior to ablative treatment;Superficial laser treatment is comestically more satisfactory than skinning vulvectomy.
Deep laser may cause scarring. |
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Simple vulvectomy | VIN, most commonly usual type: multifocal or extensive | Removal of the entire vulva usually including some subcutaneous tissue. | Tissue available for pathological evaluation. | |
Skinning vulvectomy | VIN, usually usual type: multifocal or large and confluent | Removal of the vulvar skin along an avascular plane beneath the epidermis, leaving the subcutaneous tissue. | Rarely used unless other treatments have failed. May need skin graft. | |
Topical medical treatment | VIN, usually usual type | Application of Imiquimod cream (Aldara) to individual lesions: 1 x a week x 2 weeks, then 2 x a week x 2 weeks, then 3 x a week till lesions are gone or up to 16 weeks |
Must evaluate with colposcope and biopsy for cancer prior to topical treatment. Response rate varies. |
Updated 7/11/14 Link to VIN in Atlas