Oncology (General Cancer)/VIN2

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Question
1 1/2 years ago the results of a biopsy was possitive for possible early stage VIN.  I was treated with Imiqunoid for 3 months. Although the lesion disappeared, I felt like it was still there. Four months later, the suspicious area returned and looked much worse than it had looked previously. This time the biopsy was positive for high grade differentiated VIN2. I am HPV negative but have been treated for lichen sclerosis for 27 years. A year ago, a Gyn oncologist removed "kissing lesions."  He got clear margins.  There was no lymph node involvement. Pathology report revealed that there was nothing worse than VIN2. Until two weeks ago, post op checks were fine.  I am now scheduled for a biopsy of a suspicious lesion on a different area than a year ago. The oncologist doesn't think it is cancer, but suspects neoplasia.  Despite using Clobetasol to control lichen sclerosis, I am faced with another suspicious area.

Does DIFFERENTIATEZD VIN pose a greater risk than undifferentiated VIN to progress to cancer

Answer
Although differentiated VIN is considered a precursor to vulvar squamous cancer, it doesn't always lead to that.  Undifferentiated VIN is not clearly a precursor.  However, given your history I would certainly continue careful and frequent surveillance.  There was a study a few years ago in which patients with lichen sclerosis who eventually developed cancer were studied.  Expert pathologists reviewed the slides from the past and found that differentiated VIN had been missed in many of the cases.  However short of major surgery, I think surveillance is the best approach.

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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