Treatment of Vulvar Intraepithelial Neoplasia in Non-HPV-Related (Differentiated-Type) Disease
Differentiated-type VIN (dVIN) is a distinct subtype that arises independently of human papillomavirus infection. This protocol applies to non-pregnant, non-immunosuppressed patients with histologically confirmed differentiated-type vulvar intraepithelial neoplasia.
Clinical Scenario
Differentiated-type VIN is not causally related to HPV and is much less frequent than HPV-associated (usual-type) VIN. The patient is not pregnant and not immunosuppressed.
Treatment Approach
A surgical approach is the treatment of choice. The extent of the procedure depends on the distribution and size of the lesion — the full protocol details the technique, required margins, and the approach used when disease is more widespread.
References
- Differentiated-type VIN is not causally related to HPV and is much less frequent than HSIL (usual-type VIN).
- The treatment of choice for differentiated-type VIN is excision.
- Excision of the whole lesion with a safety margin of 0.5 cm around the visible lesion (or less for lesions in which other anatomical structures such as the anus, urethra, or clitoris may be compromised) and a minimum depth of 3 mm in hairy areas and 1 mm in non-hairy areas.
- Widespread VIN lesions involving most of the vulva require skinning vulvectomy.