VIN is an increasingly common problem, particularly for women in their 40s, and should be considered a premalignant condition. A low threshold for consideration, biopsy and follow up should be maintained.
In 2015 terminology for VIN was changed by the International Society for the Study of VulvoVaginal Disease (ISSVD) to unify nomenclature for HPV associated lesions of the cervix, vagina and vulva. In the new classification, low-grade squamous intraepithelial lesion of the vulva (vulvar LSIL) corresponds to ‘condyloma’, or ‘HPV effect’. High-grade squamous intraepithelial lesion of the vulva (vulvar HSIL) includes ‘usual type VIN’ (warty, basaloid type or mixed). Differentiated type VIN is unchanged from the 2004 classification. Of these three types, differentiated VIN is usually not HPV associated, being more often associated with a vulvar dermatologic condition such as lichen sclerosis, and with squamous cell carcinoma of the vulva.
ACOG ASCCP Committee Opinion No. 675: Management of vulvar intraepithelial neoplasia
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