Vulval intraepithelial neoplasia (VIN) is a skin disease where the cells on the surface of the vulva are abnormal and could change into a cancer. Find out about surgery for VIN.
The type of surgery you need depends on how much of your vulva the VIN is affecting. The most common operation is called a wide local excision, more rarely some women need an operation called a skinning vulvectomy.
Wide local excision
A wide local excision is when the surgeon removes the area of skin affected by VIN and a border of healthy tissue around it. This is called a margin.
How much skin your surgeon will need to remove depends on how big an area of the vulva is affected.
Rarely, if the VIN is very widespread, your surgeon may need to do an operation called a skinning vulvectomy. This means removing the skin over a large area. Because the affected cells are only on the vulval surface, it is possible to take away only the skin and leave the healthy tissue underneath.
The surgeon may be able to stitch the remaining skin back together. Or you may need a skin flap (or less often a skin graft) to repair the area, but your surgeon will avoid doing this if at all possible.
A skin flap is an area of healthy skin with its blood supply, which is moved from close by to cover the area where skin has been removed.
Skin grafting is used less often than a skin flap. Grafting means your surgeon takes some healthy skin from another part of your body and stitches it over the site of the operation. The healthy skin is most often taken from your inner thigh – this is called the donor site. The donor site will heal on its own over a few weeks.
Diagrams of a skinning vulvectomy
This first diagram shows the area of skin the surgeon will remove during the operation.
The second diagram (below) shows the vulva after removal of the skin.
This third diagram (below) shows the vulva with the remaining skin sewn back together after the skinning vulvectomy operation. The diagram shows the stitches.
Once the area has healed, these should be smooth, neat lines of scar tissue. Above the vagina, you can see the opening of the bladder (the urethra) and the clitoris, both in place as before the operation.
Information and support
You won't need to be told that this is a cancer affecting a deeply personal and private part of your body. A few people prefer not to know about their operation in advance. But for most women, it may help you to cope better if you understand exactly what is going to happen. It is important to feel supported.
Most hospitals carrying out this type of treatment will have a clinical nurse specialist supporting women having treatment for gynaecological problems. This nurse is there to answer your questions or just talk about how you are feeling. If the nurse specialist isn't introduced to you when you first go to the hospital after your diagnosis, do ask. You can make an appointment to see her.
There should be information available for you to take home with you. Ask your surgeon or specialist nurse for a booklet or printed web pages that you can read through yourself. This will help you to work out what questions you need to ask next time you go to the hospital. Or you can talk to your GP, who will be in contact with the surgeon and should be able to tell you what will happen.
There is a UK support organisation for women having vulval cancer treatment. It is run by women who have been through what you are going through. Talking to another women who's already been there may be a big help. They are called VACO.