Vulvar Dysplasia

When you have abnormal skin changes in the vulva but it’s not cancer, it’s called vulvar dysplasia also called vulvar intraepithelial neoplasia (VIN). VIN is divided into categories, low-grade VIN or high-grade VIN. High-grade VIN is associated with a greater risk of progressing to cancer. 

VIN signs and symptoms are general, but it’s important to see your doctor to make sure VIN doesn’t get worse. They can include: 

• Itching or burning on the vulva 
• Visible skin color changes to white, grey, pink, reddish, or dark brown 
• Skin thickening or a new growth that looks like a wart 
• Cracks or ulcerations in the vulvar skin 

Most cases of VIN can be cured with proper treatment and follow-up. If left untreated, VIN can  progress to vulvar cancer. 

Although vulvar cancer is rare, VIN is becoming more common. According to the U.S. Surveillance, Epidemiology, and End Results program, VIN is now four times more common than it was in the 1970s. VIN is usually seen in women in their 40-50s. 

Risk Factors

Risk factors for VIN include human papillomavirus (HPV) infection, cigarette smoking, lichen sclerosis of the vulva, and having a weakened immune system. 

If you have any of these risk factors, you should do vulva self-checks and see your doctor if you notice worrisome changes. 

Screening

Your doctor will examine the vulva during a regular gynecologic exam. It’s important to bring up any unusual symptoms to your doctor. 

If there are abnormal skin areas, your doctor will take a small tissue sample, called a biopsy. They’ll send the tissue sample to a pathologist, who looks for abnormal cells under a microscope. The biopsy results will tell you what type of dysplasia you have, which will determine your course of treatment. 

Prevention

You can prevent VIN by getting the HPV vaccination. It’s effective in protecting you against the high-risk strains of HPV that cause this type of dysplasia. 

Quitting smoking can also reduce your risk of getting vulvar high-grade squamous intraepitheleial lesion (HSIL) and your risk of this dysplasia developing into cancer. 

Treatment

You will work with your care team to determine the best course of treatment. Generally, your doctor will remove the abnormal area in one of these ways. All of these treatments can work well. 

Laser ablation, which uses a laser beam to burn away abnormal tissue. This minor procedure is done in an outpatient center under anesthesia. You’ll probably go home the same day. 

Topical therapy, which applies medication to the affected area for several weeks. These medications might be imiquimod and fluorouracil (5-FU). 

Surgical excision, which involves cutting away the affected area with a margin of normal tissue around it. This procedure is done in an operating room under anesthesia. You might have surgery if other treatments don’t work or if your doctor is worried that you have vulvar cancer. 

Follow-Up

Because you’re at risk for VIN recurring throughout your lifetime, you will need close follow-up with a gynecologic oncologist or gynecologist who knows the skin changes associated with VIN. You’ll typically have follow-up visits every six to 12 months after treatment.