Pre-cancer of the Vulva (VIN)

Cancer of the vulva is rare. Before a cancer forms, there is a pre-cancer phase. This has long been called VIN (Vulval Intraepithelial Neoplasia) but this term has now officially been replaced by High grade Squamous Intraepithelial Lesion (HSIL) of the vulva.
We aim to diagnose and treat vulval pre-cancer before it becomes a cancer.

Some vulval cancers are associated with chronic inflammatory conditions such as lichen sclerosis or lichen planus. For this reason, if you suffer from one of these disorders you should have regular follow up with your specialist.
Other vulval cancers are caused by a virus; Human Papilloma Virus (HPV). This is the same virus that causes pre-cancer and cancer of the cervix. It is very important that you have regular checks of the cervix if you suffer from pre-cancer of the vulva.
It seems that some women struggle to 'shift' HPV and the longer it remains active in the body, the more chance it has to cause pre-cancerous change. We know that smokers are more likely to have persistent infections as are women with reduced immune systems (eg transplant patients or those women taking immune reducing therapies such as methotrexate).

Common Symptoms
Pre-cancer of the vulva can present in a variety of appearances. Patients usually notice lumps or bumps on the vulval skin. These can sometimes look warty. There is usually a colour change but this is very variable. Lesions can be red, white, brown or black. Often, patients complain of vulval soreness and, less commonly, itching.

Diagnosis
Examining the vulva can reveal whether a lesion is likely to be pre-cancer. Sometimes a microscope is used to perform a detailed examination (a vulvoscopy). If your specialist thinks you have pre-cancer of the vulva, a biopsy (small piece of tissue) is taken to confirm the diagnosis. The biopsy can be taken in clinic using some local anaesthesia.

Treatment
The options available for treating pre-cancer of the vulva are surgical or medical.

• Surgery is the 'gold standard' and usually involves cutting away the disease. This is done as a day case procedure in theatres under general anaesthesia. Dissolvable sutures are used to close the skin. Sometimes, the disease is treated by heat or laser treatments.
• Medicine called Imiquimod can be used (off license) to treat pre-cancer of the vulva. It works by stimulating the immune system locally when it is applied to the lesion. Common side effects are burning sensation, redness and irritation. It is usually applied for up to four months but your specialist will direct you.

Many factors are taken into account when planning treatment and your specialist will tailor your treatment to your individual needs and circumstances. All women with pre-cancer of the vulva are advised to stop smoking.

Recurrence
It is not uncommon for pre-cancer of the vulva to recur in time. Even after treatment, you will need to be kept on surveillance some time. If you are someone that has had recurrent vulval pre-cancer, it is likely that you will need long term specialist follow up.
Stopping smoking will improve your chances of not experiencing recurrent disease.

Follow up
Expect to be seen by your specialist every three to six months initially after treatment. If there are no signs of recurrence, follow up can often be on an annual basis.