Vulvar Intraepithelial Neoplasia (VIN)

Question 1

Usual-Type VIN
(HSIL)
What is the cause?

Answer 1

-Human Papilloma Virus

(16 and 18), persistent infection

Question 2

In which age group is it most common?

Answer 2

• Younger women
• Smoking
• RVD positive

Question 3

What do the lesions in usual-type VIN look like?

Answer 3

-The lesions are
multi-focal,
hyper or
hypopigmented

Question 4

What is the management of Usual-type VIN?

Answer 4

-Surgical Mx
Excision
Laser

(Do not preserve the vulva(external part of female genitalia) and do not target HPV specifically)

• Medical treatment
• Imiquimod (Aldara)

Question 5

What is IMIQUIMOD (Aldara)?

Answer 5

• It is an immunomodulator
• Imiquimod activates macrophages and dendritic cells to release IFN- ALPHA and pro-inflammatory cytokines in vulval skin.
• Effective and safe in treating warts and VIN resulting from HPV.
• Limited by local side effects

Question 6

What is Differentiated VIN?

Answer 6

-VIN not associated with HPV.

-associated with Lichen Sclerosus and
Squamous Carcinoma

Question 7

In which age group is Differentiated VIN common?

Answer 7

Older women

Question 8

What does the lesion of differentiated VIN look like?

Answer 8

-It is a unifocal lesion