Vulvar Lichen Sclerosus and Neoplastic Transformation: A Retrospective Study of 976 Cases.

J Low Genit Tract Dis

1Department of Gynecology and Obstetrics, University of Torino, Torino; 2Preventive Gynecology Unit, European Institute of Oncology, Milan; and 3Pathology Unit, S. Anna Hospital of Torino, Torino, Italy.

Published: April 2016

AI Article Synopsis

  • The study aimed to evaluate the potential for cancer (neoplastic transformation) in women with vulvar lichen sclerosus (VLS), based on a review of 976 cases.
  • The average age of diagnosis was 60 years, with a follow-up period averaging 52 months; out of the participants, 34 developed neoplasia, showing a 3.5% risk and an increasing probability of progression over time, peaking at 36.8% after 25 years.
  • Results indicated that older women (70 years and older) had significantly shorter intervals without progression to neoplasia, emphasizing the need for lifelong monitoring and early detection of preinvasive lesions to mitigate the risk of vulvar cancer

Article Abstract

Objective: The aim of the study was to estimate the neoplastic potential of vulvar lichen sclerosus (VLS).

Materials And Methods: This was a retrospective study of 976 women with VLS. We recorded age at diagnosis of VLS, length of follow-up, and type of neoplasia, categorized as the following: (1) vulvar intraepithelial neoplasia (VIN), further subdivided in differentiated VIN (dVIN) and high-grade squamous intraepithelial lesion; (2) superficially invasive squamous cell carcinoma; and (3) frankly invasive squamous cell carcinoma. Neoplasia incidence risk, neoplasia incidence rate, and cumulative probability of progression to neoplasia according to the Kaplan-Meier method were estimated. Log-rank test was used to compare the progression-free survival curves by age at diagnosis of VLS.

Results: The mean age at diagnosis of VLS was 60 (median = 60; range = 8-91) years. The mean length of follow-up was 52 (median = 21; range = 1-331) months. The following 34 patients developed a neoplasia: 8 VIN (4 dVIN, 4 high-grade squamous intraepithelial lesions), 6 keratinizing superficially invasive squamous cell carcinoma (5 with adjacent dVIN), and 20 keratinizing invasive squamous cell carcinoma (1 with adjacent dVIN). The neoplasia incidence risk was 3.5%. The neoplasia incidence rate was 8.1 per 1,000 person-years. The cumulative probability of progression to neoplasia increased from 1.2% at 24 months to 36.8% at 300 months. The median progression-free survival was significantly shorter in older women (≥70 years) when compared with that in younger women (p = .003).

Conclusions: Vulvar lichen sclerosus has a nonnegligible risk of neoplastic transformation and requires a careful and lifelong follow-up in all patients, particularly in elderly women. Early clinical and histological detection of preinvasive lesions is essential to reduce the risk of vulvar cancer.

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http://dx.doi.org/10.1097/LGT.0000000000000186DOI Listing

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