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Diagnosis & Management Of VAIN/VIN

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Presentation on theme: "Diagnosis & Management Of VAIN/VIN"— Presentation transcript:

1 Diagnosis & Management Of VAIN/VIN
Richard Hutson Gynaecological Oncologist St. James’s University Hospital

2 Definition A condition where neoplastic cells are within the boundaries of surface epithelium Excludes:- Paget’s disease of the Vulva Melanoma-in-situ Maturation disorders

3 Classification VIN/VAIN I :- mild dysplasia; lower 1/3
VIN/VAIN II :- mod. dysplasia; lower 2/3 VIN/VAIN III :- severe dysplasia; > 2/3

4 Symptoms Pruritus (38-73 %) Vulval pain / soreness A lump / lesion

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

6 Diagnosis Histologically; biopsy always required
Biopsy under LA; use of EMLA Punch / scalpel

7 Normal Epithelium with L.S.


9 VIN II with Koilocytosis

10 Paget’s Disease of the Vulva

11 Aetiology Strong association with STD’s HPV (43-79 %)
Younger women condyloma and koilocytes Older women no koilocytosis Smoking Immunosuppressed

12 Natural History of VIN / VAIN
No established rates of progression or regression Risk of invasion is small Risk of invasion more likely women > 45; immunosuppressed; SLE; multifocal disease

13 Management in Young Women
Risk of invasion is small Recurrence rate up to 84 % > 20 % recurrent disease after simple vulvectomy Regresses after pregnancy

14 Who to Treat ? Post menopausal presentation
Immunosuppressed / immunodeficient Histologically progressive lesions on serial biopsy Excessively hyperkeratotic lesions

15 Treatment Techniques W.L.E. (8mm margin)
Skinning Vulvectomy; skin graft, 27% rec. Vulvectomy; rarely employed Topical 5 FU; failure rate = % Dinitrochlorobenzene; topical immunotherapy CO2 laser; to upper reticular dermis

16 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

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