Vulvar Neoplasia

Question 1

What is VIN?

Answer 1

Vulvar intraepithelial neoplasia

Pre-malignant condition affecting the squamous epithelium

Question 2

What is usual type VIN?

Answer 2

Precursor of HPV driven vulval SCC

Typically younger patients (35-50yrs)

Question 3

What is differentiated VIN?

Answer 3

Precursor of HPV independent vulval SCC
Typically older patients
Associated with lichen sclerosis

Question 4

Treatment of VIN

Answer 4

Watch and wait
WLE
Imiquimod cream
Laser ablation

Question 5

What is the most common type of vulval cancer?

Answer 5

Squamous cell carcinoma

Question 6

Presentation of vulval cancer

Answer 6

Most frequently affects the labia majora
Vulval lump
Ulceration 
Ulcer or exophytic mass
Bleeding
Pain
Itching
Lymphadenopathy in the groin

Question 7

Risk factors for vulval cancer

Answer 7

Elderly women
Lichen sclerosis
Immunosuppression
HPV

Question 8

Investigations for vulval cancer

Answer 8

Biopsy
Sentinel node biopsy
USS groin: if any lymph nodes involved
MRI: Of the perineum if lesion is close to the anus

Question 9

Treatment for vulval cancer

Answer 9

WLE
Groin lymph node dissection
Chemotherapy
Radiotherapy