MANAGEMENT OF LICHEN-SCLEROSUS AND INTAEPITHELIAL-NEOPLASIA OF THE VULVA IN THE UK

Women with vulval intraepithelial neoplasia (VIN), lichen sclerosus (L S) and Paget's disease are referred either to gynaecologists or to der matologists, We have ascertained the caseloads, referral patterns and treatment modalities used in the two specialties. A postal questionnai re was sent to 540 consultant gynaecologists and 225 consultant and se nior registrar members of the British Association of Dermatologists. 3 50 gynaecologists and 161 dermatologists returned completed questionna ires. The workload of LS and Paget's disease was evenly distributed, w ith 54% of dermatologists and 58% of gynaecologists seeing more than s ix cases of LS per annum and less than 1% seeing more than five cases of Paget's disease, 92% of responding gynaecologists saw at least one case of VIN per year whereas 43% of dermatologists saw no cases. Patie nts with VIN and Paget's were referred to gynaecologists for treatment by 66% of dermatologists. Both groups are equally prepared to treat L S. Indications for treatment of VIN and LS were suspicion of invasion and symptoms. Local excision of VIN is the treatment of choice by both gynaecologists and dermatologists, LS is predominantly treated with t opical steroids but gynaecologists also use topical oestrogen and test osterone. The great majority of responders favoured establishing a nat ional register to study the outcome of vulval lesions.