skip to main content

Differentiated VIN — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardGenital DermatologyDifferentiated VINSCE Dermatology

A 45-year-old woman presents with a 6-month history of vulval itch. On examination she has a well-defined white plaque on the inner aspect of her right labium majus. Biopsy shows vulval intraepithelial neoplasia — differentiated type (dVIN). She has background lichen sclerosus. What is the recommended management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Excision with clear margins — dVIN carries high SCC progression risk (>30%)

Differentiated VIN (dVIN) is a high-risk precancerous lesion arising in the background of chronic inflammatory dermatoses (lichen sclerosus, lichen planus) rather than HPV infection. Unlike usual-type VIN (uVIN, HPV-associated) which has a lower and slower malignant transformation rate, dVIN carries a substantially higher SCC progression risk (>30% in some series) and can progress rapidly. Excision with histologically clear margins is the recommended treatment. Close long-term follow-up is essential as recurrence is common, particularly in the setting of ongoing lichen sclerosus. The underlying LS should continue to be treated with topical corticosteroids. dVIN can be subtle and easily missed — a high index of suspicion is needed.

Reference: BAD 2018 LS Guidelines; BSSVD VIN