What is VIN?

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Vulvar intraepithelial neoplasia (VIN) is a precancerous skin condition that affects the vulva and can lead to vulvar cancer if left untreated. Symptoms include vulvar pain and itching, and treatment options include surgery and topical chemotherapy. Risk factors include HPV, smoking, and impaired immune system function. VIN can be asymptomatic, so regular self-inspection is recommended. Treatment options have side effects, but surgery is often preferred.

Vulvar intraepithelial neoplasia, or VIN, is a precancerous skin condition that affects the vulva. This condition is not cancerous, but vulvar cancer can develop if left untreated. Many women with VIN experience symptoms such as vulvar pain, but sometimes the disease is asymptomatic. Once the condition has been diagnosed, women with VIN have several treatment options, including surgery and topical chemotherapy.

Vulvar cancer accounts for about 1% of cancers affecting only women and about 4% of cancers affecting the female reproductive organs. In fact, it’s more common for a woman to have an abnormal Pap smear than to be diagnosed with a vulvar condition. Vulvar intraepithelial neoplasia is a less common problem than cervical cell abnormalities, but it is possible for vulvar lesions to become cancerous if left untreated. It is therefore equally important that vulvar conditions are diagnosed and treated promptly.

The cause of vulvar intraepithelial neoplasia is not well understood, but a number of risk factors have been determined. Having one or more risk factors can increase your risk of developing VIN. One of the main risk factors is the presence of human papilloma virus, especially types 16 and 18. Herpes simplex type 2, which causes genital herpes, also increases the risk of developing vulvar intraepithelial neoplasia. Additionally, smoking and impaired immune system function also increase the risks.

The most common symptoms of vulvar intraepithelial neoplasia include vulvar pain and itching, or a burning or tingling sensation. One or more skin lesions may be present; these are often slightly raised and can take on anomalous colors such as grey, white, pink or red. What constitutes “abnormal” depends on the normal color of a woman’s vulva, which tends to differ between individuals. Because symptoms can vary, the diagnosis is made based on a careful inspection of the vulvar region followed by a biopsy.

For some women, VIN is completely asymptomatic. This is problematic because while most cases of VIN remain benign, a small number of cases eventually progress to vulvar cancer if left untreated. About 4% of women treated for VIN develop invasive vulvar cancer; while it is estimated that 8% of women who do not receive treatment will develop vulvar cancer. Doctors recommend that women perform a self-inspection at least every six months, to check for lesions or signs of abnormal coloring.

Women diagnosed with vulvar intraepithelial neoplasia have several treatment options, the most effective of which are topical chemotherapy, surgical excision, and laser ablation. Chemotherapy is usually done with an agent called 5-fluorouracil; however, this treatment has painful side effects, including the possibility of severe inflammation of the vulva. Even so, chemotherapy is sometimes chosen, in part because it is less likely to produce scarring than other treatment options.
Another treatment, called laser ablation, causes minimal scarring but can be extremely painful. This option uses laser technology to destroy affected tissue and is most effective if the VIN lesions are in an area where there is no hair. The last treatment option is surgery, which is often preferred because pain and healing time are reduced compared to chemotherapy and laser ablation. An added benefit of surgery is that the removed tissue can be biopsied.

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