Vulvar Intraepithelial Neoplasia

What is vulvar intraepithelial neoplasia (VIN)?

Vulvar intraepithelial neoplasia (VIN) involves having precancerous skin cells on your vulva. But this part’s important — VIN isn’t cancer. This diagnosis means that some of your skin cells are atypical and could eventually become vulvar cancer without treatment.

Fortunately, early treatment and close monitoring can prevent VIN from becoming cancer.

Other names for vulvar intraepithelial neoplasia include:

• Vulvar dysplasia.
• Squamous intraepithelial lesion (SIL).

What are the types of vulvar intraepithelial neoplasia?

There are two types of VIN that can become cancer:

• Usual type VIN (uVIN): This type accounts for the majority of VIN, with most people getting diagnosed in their forties. It’s associated with high-risk human papillomavirus (HPV) infections. “High-risk” means that the virus can cause normal cells to transform into cancer cells. uVIN is also called high-grade squamous epithelial lesions (HSIL).
• Differentiated VIN (dVIN): This type accounts for only about 5% of VIN. It’s most common in people 60 and older. It’s associated with an inflammatory skin condition called lichen sclerosus.

You may also have abnormal cells on your vulva called low-grade squamous epithelial lesions (LSIL). LSIL is associated with low-risk forms of HPV (the kind associated with genital warts). But these cells rarely become cancerous. Often, they go away without treatment.

What are the symptoms of VIN?

Not everyone with VIN has symptoms. But if you do, they may include:

• Vulvar itching (vulvitis).
• Burning, soreness or tingling in your vulva.
• Skin changes, including new growths or discoloration.
• Pain during intercourse.

What does vulvar intraepithelial neoplasia look like?

VIN can appear in different ways. The main thing to look out for is skin changes on your vulva. Signs include:

• New growths that are raised or flat.
• Portions of skin that appear white, red, pink, gray brown or black.
• Changes appearing on just one part of your vulva or on many parts.

What causes vulvar intraepithelial neoplasia?

Experts haven’t identified a single cause.

But most people diagnosed with VIN also have a high-risk form of HPV. HPV is a sexually transmitted infection (STI) that spreads through skin-to-skin contact. This means that various forms of sexual contact — not just intercourse — spread the virus. Infection puts you at risk of developing VIN.

People without HPV infections who develop VIN usually have lichen sclerosus. This condition causes inflammation and scaly skin patches on your vulva.

Which HPV causes VIN?

High-risk strains of HPV associated with VIN include types 16, 18 and 33. Most people diagnosed with VIN are infected with HPV-16.

What are the risk factors associated with VIN?

Risk factors associated with developing VIN include:

• Having a compromised immune system.
• Having chronic (long-term) vulvar irritation.
• Smoking.

What are the complications of VIN?

The greatest risk of VIN is that without treatment it can become cancer. The timeline depends on the type of VIN.

• uVIN (HPV-related VIN) usually takes six to seven years to become cancer.
• dVIN usually takes two to three years to become cancer.

Early treatment can prevent precancerous cells from becoming cancer cells.

How is VIN diagnosed?

Your healthcare provider will perform a physical exam, ask about your symptoms and check your vulva for suspicious growths or discoloration. They may perform a colposcopy. During this procedure, providers use a lighted instrument called a colposcope to get a better view of your vulva or vagina.

A biopsy is the only way to know for sure if you have VIN. Your provider will remove a portion of the suspicious-looking tissue so a pathologist can test it in a lab for precancerous cells.

How is VIN treated?

Treatment involves removing or destroying the precancerous cells while preserving the feeling and function of your vulva.

Treatments include:

• Surgery: Your provider may cut out the suspicious areas. Typically, treatment involves removing the abnormal cells and a small margin of healthy tissue to ensure no precancerous cells remain.
• Laser ablation: Instead of using sharp tools to remove precancerous cells (as with surgery), your provider may cut the tissue with heated lasers. As with surgery, they’ll also remove a margin of healthy tissue.
• Topical cream: Your provider may prescribe imiquimod. You’ll apply this cream directly to your skin to destroy the abnormal cells.
• Skinning vulvectomy: You may need to have the skin on your vulva removed if the precancerous cells are widespread. But this is rare.

Can VIN go away on its own?

VIN can go away on its own, but this doesn’t happen often. It’s more likely that the cells either remain precancerous or progress to cancer.

Given the stakes, it’s not worth the chance. Your healthcare provider will likely recommend treatment so you’re not at risk of developing cancer.

Can VIN prevented?

There’s no one foolproof prevention method. But the best way to reduce your risk of VIN is to get the HPV vaccine. It can protect you from the high-risk strains of HPV that can become cervical cancer or vulvar cancer.

You can also:

• Practice safer sex. Limiting your number of sex partners and using barrier methods (like condoms and dental dams) don’t prevent HPV infections. But they can reduce your risk.
• Get treated for lichen sclerosus. Seeing a provider at the first signs of lichen sclerosus symptoms (white, raised spots that are itchy or sore) can help you get diagnosed and treated early. Managing symptoms can prevent the cell damage that may put you at risk of VIN.
• Get regular Paps. Visiting your gynecologist for regular Pap smears can help them catch suspicious tissue early when it’s treatable. Often, providers perform HPV tests during Paps to detect high-risk strains of the virus.

What can I expect if I have VIN?

Your prognosis is excellent with treatment. It’s likely you’ll never develop vulvar cancer.

Still, once you’ve had VIN, there’s always a chance that it’ll return (recur). It’s more likely to recur if you smoke.

Your healthcare provider will monitor you closely to get rid of any new precancerous cells. They can help you quit smoking so a recurrence is less likely.

How do I take care of myself?

Follow your healthcare provider’s guidance on how frequently you’ll need follow-up visits after treatment. Many people need to return twice a year for five years after treatment. If there are no signs of VIN, you may only need annual visits.

Your provider will advise you based on your diagnosis and treatment response.

What questions should I ask my healthcare provider?

Questions to ask include:

• What type of VIN do I have?
• What treatments would you recommend?
• What treatment side effects should I expect?
• What changes will let me know if VIN has returned?
• How often will I need follow-up visits?

A note from Cleveland Clinic

Learning that you have suspicious tissue — even tissue that’s not cancer — can feel terrifying. Just remember that precancerous cells aren’t the same as cancer cells. They don’t always progress to cancer. Still, it’s better to get treatment that destroys the cells to avoid the chances of a cancer diagnosis. Learning you have VIN means your provider caught precancerous changes in time. With treatment and close monitoring, you can live a healthy life free of vulvar cancer.