Diagnosis

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Diagnosis Management Of VAIN/VIN

• Richard Hutson
• Gynaecological Oncologist
• St. Jamess University Hospital

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Definition

• A condition where neoplastic cells are within the
  boundaries of surface epithelium
• Excludes-
• Pagets disease of the Vulva
• Melanoma-in-situ
• Maturation disorders

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Classification

• VIN/VAIN I - mild dysplasia lower 1/3
• VIN/VAIN II - mod. dysplasia lower 2/3
• VIN/VAIN III - severe dysplasia gt 2/3

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Symptoms

• Pruritus (38-73 )
• Vulval pain / soreness
• A lump / lesion
• Asymptomatic

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Physical Signs

• Papular rough surfaced (warts)
• Macular with indistinct/irregular borders
• Micropapillary/granular associated with
  acanthosis
• Pigmentation (brown/black)
• White lesions (hyperkeratosis)

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Diagnosis

• Histologically biopsy always required
• Biopsy under LA use of EMLA
• Punch / scalpel

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Normal Epithelium with L.S.
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VIN II-III
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VIN II with Koilocytosis
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Pagets Disease of the Vulva
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Aetiology

• Strong association with STDs
• HPV (43-79 )
• Younger women condyloma and koilocytes
• Older women no koilocytosis
• Smoking
• Immunosuppressed

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Natural History of VIN / VAIN

• No established rates of progression or regression
• Risk of invasion is small
• Risk of invasion more likely women gt 45
  immunosuppressed SLE multifocal disease

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Management in Young Women

• Risk of invasion is small
• Recurrence rate up to 84
• gt 20 recurrent disease after simple vulvectomy
• Regresses after pregnancy

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Who to Treat ?

• Post menopausal presentation
• Immunosuppressed / immunodeficient
• Histologically progressive lesions on serial
  biopsy
• Excessively hyperkeratotic lesions

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Treatment Techniques

• W.L.E. (8mm margin)
• Skinning Vulvectomy skin graft, 27 rec.
• Vulvectomy rarely employed
• Topical 5 FU failure rate 38-100
• Dinitrochlorobenzene topical immunotherapy
• CO2 laser to upper reticular dermis

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Summary

• HPV and multifocal disease commoner in young
  women
• Unifocal and HPV neg. lesions in post-men. Women
• CIN found in 33 of women with VIN
• VIN assoc. with 25-33 vulval cancers
• 50 vulval cancers assoc. with non-neoplastic
  disorders