Vulvar dysplasia, or vulvar intraepithelial neoplasia (VIN), is the spectrum of change that occurs in the skin cells of the vulva that can lead to cancer over time. The cellular changes in the vulva may be secondary to infection with the human papilloma virus (HPV) or, less commonly, secondary to chronic inflammation. Vulvar dysplasia can be mild, moderate, or severe. When severe, it is considered a pre-cancer, but it may never reach the cancerous stage. However, if severe vulvar dysplasia does worsen along a timeline without intervention, invasive cancer of the vulva may develop after several years.
- The exact cause of vulvar dysplasia has not been established, but it has been linked to:
- Human papilloma virus (HPV)(strongest link)
- Chronic vulvar irritation
- Genital herpes simplex virus
- Lichen sclerosus of the vulva
- Granuloma inguinale (a sexually transmitted disease, STD)
Signs and symptoms of vulvar dysplasia may vary, but they include:
- Chronic vulvar itching
- Burning, tingling, or soreness of the vulva
- Change in the appearance/color of the vulva: white to gray, red to brown to black discolored skin
- Slightly raised discrete lesions on the vulva; some may appear darkened like a mole or freckles
- Flat grey lesions on the vulva
- Pain during sex
Unlike for the cervix, there are no screening strategies for early detection of vulvar dysplasia. Detection of vulvar dysplasia is limited to visual recognition with confirmation by biopsy. Visual recognition may be with the naked eye or using the colposcope. The colposcope is a magnifying scope that allows close inspection of the vulva to look for lesions that are not plainly visible or clearly demarcated. The colposcope is otherwise most commonly used for the detection of cervical dysplasia.
Treatment is recommended for all women with biopsy-proven moderate to severe vulvar dysplasia because its clinical course cannot be predicted and may progress to invasive cancer.
Surgical removal by wide local excision of the dysplastic area should be performed and the specimen sent to a pathology lab for microscopic evaluation. Alternatively, laser ablation can be used to vaporize the dysplastic lesion if cancer is not suspected. Non-surgical treatment is also an option using topical imiquimod 5% cream (although it is used off-label, i.e., it is not FDA-approved, for this indication) if cancer is not suspected.
Recurrence rates after treatment range from 9% to 50% with all treatment regimens and are higher if the excised specimens have dysplastic cells are seen their margins under the microscope. Higher recurrence rates are also seen if there are more than one dysplastic lesion. Women with vulvar dysplasia appear to be at risk for recurrent disease throughout their lifetime.
It is prudent for a woman to self-examine and visit her gynecologist regularly as instructed to detect a recurrence. Given the relatively slow rate of progression of vulvar dysplasia, women with a complete response to therapy and no new lesions at her 6 month and 12 month follow-up visits after treatment can be monitored every year by visual inspection thereafter unless any signs or symptoms of recurrence intervene in the meantime.
We at Adaptive Gynecology have extensive experience in detecting and managing vulvar dysplasia. Diagnosis and treatment is available in the office setting.
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