New developments in the management of VIN

Surgical local excision is a common treatment for VIN2/3. Rotational skin flap procedures are increasingly used when a large area of vulval tissue requires excision. The carbon dioxide laser is also employed for either ablation or excision of high-grade VIN, especially in non-hairy vulval skin. Ablative therapies do not allow histological assessment and unrecognised malignancy may be missed. Medical treatments, such as topical 5% imiquimod cream, or photodynamic therapy with topical 5-aminolaevulinic acid, result in comparatively poor clearance rates of VIN2/3 and long-term outcomes have not been reported. The importance of treatment-related morbidity on sexuality should not be overlooked. HPV vaccines offer an alternative approach. Early work on therapeutic HPV vaccination for high-grade VIN shows that vaccines can stimulate an immune response but not significant clinical improvement. Prophylactic vaccination may be an exciting way to prevent HPV-related diseases, including VIN.