Vulvar Intraepithelial Neoplasia

VIN or vulvar squamous dysplasia is a common cause of vulvar burning that is often missed by the health-care provider. VIN is categorized as VIN I (mild dysplasia), VIN II (moderate dysplasia), and VIN III (severe dysplasia, carcinoma in situ) (7). Women with VIN can present clinically with the predominate symptom of vulvar burning (6), which can be intermittent or constant. Women may or may not have a prior documented history of human papilloma virus infection. Frequently, the vulvar examination is normal or there may be unifocal

Figure 6 VIN I and II: acetowhite changes in the posterior fourchette and the left labia. (See color insert pp. 4 and 5.)

or multifocal lesions present. When lesions are present, as is seen typically in VIN III, their appearance can vary. They can be hypo- or hyper-pigmented, flesh colored, and can be hyperkeratotic. A 3% solution of acetic acid-soaked cotton balls, when applied to the vulvar area for three to five minutes, will cause abnormal skin to turn white. An excisional biopsy of a representative acetowhite area or suspicious lesion is required for pathological confirmation of the diagnosis of VIN (Figs. 6 and 7).

VIN I and II can be treated topically with 1% 5-fluorouracil cream (Fluoroplex®, Allergan, Inc., Irvine, CA, U.S.A.) or 5% imiquimod cream (Aldara™, 3M, St. Paul, MN, U.S.A.). During treatment with topical therapy, it is useful to have the patient adhere to strict vulvar skin care hygiene guidelines, as the topical medications used are known chemical irritants. VIN III lesions require surgical excision or laser ablation.

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