Incidence of vulval squamous cell carcinoma in women with vulval lichen sclerosus in an Australian tertiary referral centre

Introduction: Women with vulval lichen sclerosus (VLS) have an increased risk of developing squamous cell carcinoma (SCC). Prevalence rates of 4-6% have been reported. New evidence suggests that at least three times weekly proactive use of topical corticosteroids (TCS) may reduce this risk significantly.1 Current treatment guidelines at the Royal Women’s Hospital (RWH), Melbourne, recommend that once symptom control is achieved the minimum frequency and strength of TCS to maintain control should be used.
Aim: To determine the incidence of vulval intraepithelial neoplasia (VIN) and SCC in the VLS population during routine follow up at the RWH.
Methods: We conducted a retrospective case note review of patients seen in the vulval clinic at the RWH with a clinical or histological diagnosis of VLS between 10th July 2012 through 5th April 2016 and determined the incidence of SCC/VIN.
Results: 504 women with VLS were identified. The Incidence of SCC and VIN was 0.2% and 0.9% respectively. The mean time from presentation to VIN/SCC diagnosis was 4.5 years.
Conclusions: The incidence of vulval SCC in this population was significantly lower than previously reported. This is likely to be an underestimate due to loss to follow-up; however, it provides support for the current guidelines in use at the RWH. An incidence of 0% was reported with vigilant at least three times weekly use of TCS and this should be the treatment goal, along with reduced scarring and fewer relapses.1 Further studies are required to definitively guide long-term management.
1. 1. Lee A, Bradford J, Fischer G. Long-term management of adult vulvar lichen sclerosus. A prospective cohort study of 507 women. JAMA Dermatol. 2015; 151(10): 1061-1067.

Dr. Rowena Meani

Skin & Cancer Foundation Inc. Victoria