Vulvar Cancer: Precancerous Changes

What is vulvar intraepithelial neoplasia?

Vulvar intraepithelial neoplasia (VIN) is a precancerous change in your vulva. VIN means there are changed cells, but not cancer. If VIN isn't treated it can turn into cancer. Intraepithelial means that the precancer cells are only in the surface of the vulvar skin.

Another name for VIN is dysplasia. This term isn't used much anymore.

The last stage of VIN before it becomes invasive cancer is called carcinoma in situ. The cell changes become more serious as they progress toward cancer. But this process may take many years. This is why regular health checkups are important. Finding and treating VIN can keep it from becoming cancer.

Understanding the vulva

The vulva is the outer part of the female reproductive system. It’s also called the external genitalia. The vulva includes:

• Mons pubis. This is the rounded area in front of the pubic bones. It becomes covered with hair at puberty.

• Labia majora. The outer folds of skin on each side of the vulva.

• Labia minora. The inner folds of skin on each side of the vulva.

• Prepuce or hood of the clitoris. This is made by the top of the inner folds of the vulva where the labia minora meet.

• Clitoris. This is below the prepuce. It’s a sensitive piece of tissue that swells with blood when stimulated.

• Fourchette. This is where the labia minora meet at the bottom of the inner folds of the vulva.

• Perineum. The area between the fourchette and the anus.

What are the symptoms of VIN?

VIN seldom causes symptoms. So, most women don't know they have it. These may be signs of VIN:

• Mild to severe itching or burning on the vulva that doesn't go away

• Changes in the skin color on the vulva. It may be white, pink to red, gray, or dark brown.

• Thickening of the skin on the vulva

• A lump or bump on the vulva

• A sore or cracked skin on the vulva

How does my healthcare provider know I have VIN?

Your healthcare provider may believe you have VIN after looking at your vulva. But you’ll need a biopsy to be sure of the diagnosis. A biopsy is done by taking a tiny piece of tissue from the changed part of the vulva. It's sent to a lab where it's tested for cancer or precancer cells.

What can I do to reduce my risk for VIN?

VIN has been linked to HPV (human papillomavirus) and cigarette smoking. Quitting smoking can reduce your risk. (It also has many other health benefits.) Ask your healthcare provider for help quitting. Limiting your number of sex partners and using condoms may also help reduce your risk for VIN. Getting the vaccine for HPV can decrease your risk for certain types of HPV related to vulvar cancer. The vaccine must be given before an HPV infection. Ask your healthcare provider if this vaccine is right for you.

If you’ve been diagnosed and treated for VIN, pay close attention to your body. Do regular self-exams of your vulva to watch for changes. Also, get your checkups. Tell your healthcare provider if you have pain or burning in your vulva or if you have any skin changes.

Getting regular pelvic exams can help reduce your risk of vulvar cancer. VIN develops slowly. Regular checkups mean your healthcare provider can find VIN while it’s small and easier to treat. Finding and treating VIN early helps reduce the chance that the changed cells will progress to cancer.

How is VIN treated?

VIN should be treated or followed by a specialist who deals with vulvar diseases.

Treatment is used to destroy or remove all of the precancer cells. Surgery is often used to cut out the changed area of skin and an edge of normal tissue around it. This is done to help be sure that all the changed cells have been removed. Another choice might be laser treatments to burn out the VIN cells.

In some cases, a topical medicine can be put right on the changed skin of the vulva. Medicines used include imiquimod or fluorouracil (5-FU) creams. Fluorouracil is a type of topical chemotherapy.

The type of treatment used and the long-term changes to the vulva depend on many factors. These include the type of VIN, where it is on the vulva, and the size of the changed area. Your preferences are also important. Talk with your healthcare provider about your treatment choices so you can make the choice that's best for you.

Talk with your healthcare provider

If you have questions about VIN or your risk for vulvar cancer, talk with your healthcare provider. They can help you understand more about this precancer and what it means for you.