vulval intraepithelial neoplasia

Last reviewed 01/2018

Vulval intraepithelial neoplasia is the pre-invasive phase of carcinoma of the vulva.

  • affects 20-30 per 100,000 women
  • approximately 40% of cases occur in women under 41
  • aetiological factors include human papilloma virus (HPV) and immunosuppression

  • clinical features
    • pruritus vulvae
    • abnormal skin lesion of vulva

  • investigation - skin biopsy

  • management
    • surgery is often considered the treatment of choice for vulvar intraepithelial neoplasia (1)
      • removes all visible lesions, with the aim of relieving symptoms and preventing vulvar cancer
      • however, there are limitations to surgery
        • percentage of lesions with positive surgical margins ranges from 24 to 68%
        • recurrences are common, because surgery does not eliminate HPV
        • surgery can mutilate the vulva, thereby causing psychosexual distress
    • careful monitoring might be considered by some clinicians - approximately 6% of lesions become malignant
    • topical steroids may have a role in symptomatic treatment
    • if VIN is diagnosed then there is a >10% risk of neoplasia elsewhere, generally cervical. Thus if VIN is diagnosed then an examination of the cervix and breasts should be undertaken

Notes:

  • the use of imiquimod 5% cream, a topical immune-response modifier, for treatment of the VIN
    • a study assessed the effectiveness of imiquimod 5% cream in patients with multifocal grade 2 or 3 vulvar intraepithelial neoplasia in a placebo-controlled, double-blind, randomized clinical trial
    • the study revealed that imiquimod 5% cream reduced lesion size in patients with vulvar intrapithelial neoplasia

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