What are the aims of this leaflet?
This leaflet has been written to help you understand more about
What are the aims of this leaflet?
This leaflet has been written to help you understand more about vulval intraepithelial neoplasia. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.
What is vulval intraepithelial neoplasia?
Vulval intraepithelial neoplasia (VIN) is a condition that affects the skin of the vulva. The vulva is the outer part of the female genital area, surrounding the opening of the vagina. It includes the labia majora (outer lips) and labia minora (inner lips), and the clitoris.
Cells are the building blocks of the body. ‘Neoplasia’ is the abnormal growth or production of too many cells. Such growth can be cancerous or non-cancerous. The epithelium forms the top layer of the skin (epidermis), including the skin of the vulva. So, ‘intraepithelial neoplasia’ is the abnormal growth of cells in the top layer of the skin.
While ‘neoplasia’ may be associated with cancer, VIN is not a cancer. However, it is considered a precancerous condition. This means that, if left untreated, it could lead to cancer. When treated, the risk of VIN turning into cancer is low (usually, less than 5 out of 100 of those affected).
What causes vulval intraepithelial neoplasia?
There are two types of VIN, ‘usual type VIN’ and ‘differentiated VIN’. The causes for these types are explained below.
- Usual type VIN (uVIN) occurs mainly in women aged under 50 years.
- Human Papilloma Virus (HPV) infection: Many cases are linked to HPV. You may also have heard of HPV as a cause of abnormal smears. HPV infection is very common. There are over 200 different types of HPV, most of which are not associated with the development of VIN or neoplasia. However, there are two types in particular which are linked with uVIN (types 16 and 18).
- Smoking: uVIN is more common in people who smoke.
- Low immunity: Long-standing low immunity either due to other conditions or medication, can increase the risk of developing uVIN.
- Differentiated VIN (dVIN) is a rare condition. It rarely occurs in isolation and is usually found when there is another inflammatory skin condition of the vulva, such as lichen sclerosus, lichen planus, or when adjacent to vulval cancer. dVIN has a higher risk of progressing to cancer than uVIN.
uVIN is also known as vulvar high-grade squamous intraepithelial lesion (vHGSIL), high-grade VIN, VIN2/3, carcinoma in-situ, severe vulval dysplasia, Bowenoid papulosis or basaloid VIN.
Is vulval intraepithelial neoplasia hereditary?
Currently, there is no evidence that VIN is hereditary.
What does vulval intraepithelial neoplasia feel and look like?
The symptoms of VIN are very variable and include itching, pain or soreness of the vulva. Some people experience pain during sex. Up to one in five patients may experience no symptoms at all.
There may be changes in the appearance of the vulval skin, such as a colour change to red, white/pale or brown, or roughness (slightly raised or thickened areas).
How is vulval intraepithelial neoplasia diagnosed?
If a doctor or nurse suspects VIN, they will arrange for a detailed examination with a special light and magnification (vulvoscopy) and often a biopsy of the area under local anaesthesia. This assessment is usually carried out by a specialist doctor or nurse. The biopsy involves taking a small sample of the vulval skin, which is then sent to the laboratory to be looked at under a microscope. Vulval biopsies are typically well-tolerated, and the small area is usually closed with one or two dissolving stitches. The doctor will let you know the results of the biopsy and if any treatment is recommended.
Can vulval intraepithelial neoplasia be cured?
Following treatment, VIN can be cured. This is more likely if there is a single patch of affected skin. If there are several areas affected, it can be harder to achieve a long-term cure, but repeated treatment is possible.
Follow-up after treatment is usually advised and will involve re-examination of the vulval skin. If you notice any new changes in the appearance of your vulva or new symptoms occur between appointments, it is important to inform the doctor promptly rather than wait for the next follow-up appointment.
How can vulval intraepithelial neoplasia be treated?
The treatment for VIN depends on the type of VIN, the amount of skin affected, and the symptoms experienced. The treatment is usually given by a gynaecologist or in a multi-disciplinary clinic that includes at least one dermatologist and one gynaecologist.
Options available are:
- Surgery – the affected skin is removed by an operation either under local or general anaesthetic. This is often the recommended treatment for a single patch of uVIN or dVIN. Most of the time the wound is closed directly with stitches and heals well. If a large area is involved the doctor may discuss the need for additional techniques to close the wound such a skin flap (adjacent skin moved to cover the wound). Although effective, surgery is associated with risks such as scar formation and changes to the appearance of the vulva.
- Ablation treatment – the abnormal cells are destroyed, typically by use of a laser beam. Ablation treatment may allow the surgeon to preserve more normal tissue. Disadvantages include longer time to heal and possibly a higher recurrence risk than skin removal surgery.
- Imiquimod cream– this is applied to affected areas regularly for several weeks, with the aim of stimulating the body’s natural immune system to destroy the abnormal cells and allow the skin to return to normal. During this treatment, the skin usually becomes inflamed, and some people may experience flu-like symptoms, such as aches and pains, mild fever and generally feeling unwell. Taking paracetamol can be helpful. Imiquimod is a treatment to consider if there are many patches of VIN or if a large area of the vulva is affected.
- Cidofovir is an alternative immunotherapy cream which is occasionally used by certain specialist centres. Topical chemotherapy with 5-fluorouracil cream has been used in the past but its use is typically limited by severe side effects.
- Alternative treatments to remove or destroy the affected skin which have been used in the past include cryotherapy and diathermy (deep heat applied to skin tissues); but the treatment effect is hard to control precisely. In current clinical practice, these treatments are less frequently offered.
- Treatment of symptoms - there are also treatments which do not cure the condition but can help manage the symptoms. Soreness can be relieved by a local anaesthetic cream and with use of a regular moisturiser. Itch and inflammation may be helped by a steroid cream. Your doctor will advise on which treatments are most appropriate to improve your symptoms.
- No treatment – if the cell changes are mild, there are no symptoms and/or the affected area of VIN is small, no treatment may be recommended as the risks may outweigh the benefits. If this option is chosen, your specialist will keep you under regular review so that any change can be detected promptly and action taken as necessary.
Self-care (What can I do?)
It is important for you to monitor your vulval skin regularly for any changes, which should be communicated to your doctor.
Prevention
Recently effective preventative vaccines against HPV infection have become widely available for teenagers and young adults. It is hoped that the use of these vaccines may reduce the chance of uVIN developing in the future. Vaccines are not known to help VIN that has already been diagnosed.
If you smoke, you should consider stopping. You may need support from a local stop-smoking clinic.
Vulval skin affected by VIN or after treatment for VIN can be more prone to irritation by friction or detergents. This effect can be reduced by:
- ensuring vulval hygiene (daily washing)
- avoiding the use of soaps and deodorants; use an emollient moisturiser instead to cleanse
- avoiding use of fabric conditioners and biological washing powders
- wearing loose fitting cotton or silk underwear
- wearing loose fitting trousers
- using a skin emollient or simple, unscented moisturiser on the affected area regularly, even if you do not have symptoms, as this can prevent flare-ups.
CAUTION:
This leaflet mentions ‘emollients’ (moisturisers). Emollients, creams, lotions and ointments contain oils. When emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that they could catch fire more easily. There is still a risk if the emollient products have dried. People using skincare or haircare products should be very careful near naked flames or lit cigarettes. Wash clothing daily and bedlinen frequently, if they are in contact with emollients. This may not remove the risk completely, even at high temperatures. Caution is still needed. More information may be obtained at https://www.gov.uk/guidance/safe-use-of-emollient-skin-creams-to-treat-dry-skin-conditions.
Where can I get more information about vulval intraepithelial neoplasia?
Remember that you can always ask your doctor if there is anything you are unclear or worried about.
Patient support groups providing information
Vulval intraepithelial neoplasia (VIN) UK support
www.facebook.com/groups/348395735971240/about/
Vulval Pain Society:
vulvalpainsociety.org/about-vulval-pain/vulval-pain-conditions/vulval-intraepithelial-neoplasia-vin/
Vulvar Cancer Awareness Forum:
www.facebook.com/groups/515127362681303/
Web links to other relevant sources:
BAD leaflet on vulval skincare:
www.bad.org.uk/pils/vulval-skincare/
Patient UK:
www.patient.info/health/vulval-intraepithelial-neoplasia
Royal College of Obstetricians and Gynaecologists:
https://www.rcog.org.uk/for-the-public/browse-our-patient-information/skin-conditions-of-the-vulva/
Vulval Pain Society:
www.vulvalpainsociety.org/vps/
Jargon Buster:
www.skinhealthinfo.org.uk/support-resources/jargon-buster/
Please note that the British Association of Dermatologists (BAD) provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS PATIENT INFORMATION LEAFLET
PRODUCED | NOVEMBER 2024
NEXT REVIEW DATE | NOVEMBER 2027
Download File