SQUAMOUS-CELL CARCINOMA ARISING IN VULVAR LICHEN-SCLEROSUS - A LONGITUDINAL COHORT STUDY

Histological changes of lichen sclerosus (LS)-a chronic inflammatory d isease-are frequently found in association with squamous cell carcinom a (SCC) of the vulva, suggesting that women with this disorder are at increased risk, However, follow-up studies have been less convincing, showing that the vast majority of these patients do not go on to devel op cancer, In this study, a series of 211 women affected by histologic ally demonstrated vulval LS were treated with topical therapy (testost erone, clobetasol) and followed prospectively by repetitive vulval exa mination, Three patients developed SCC of the vulva (two invasive, one in situ) at the sites affected by LS during an average follow-up peri od of 1 year and 8 months, Compared with the reference population, the number of cases of invasive SCC detected significantly exceeded the n umber estimated to occur in a comparable age-matched group, The standa rdized incidence rate of vulval SCC in the LS cohort was 317 (95% CI 3 5.7-1146.2), Cumulative risk was 14.8% (0.06% in the general female po pulation), with a relative risk of 246.6, In conclusion, these data su pport the view that LS is a precursor of SCC, although characterized b y slight tendency to evolve to carcinoma, Medical treatment of LS, alt hough useful in the control of severity of disease, did not seem to be able to prevent the evolution to malignancy.