Characterization of patients with vulvar lichen sclerosus and association to vulvar carcinoma: a retrospective single center analysis

Abstract

Purpose: Lichen sclerosus (LS) is a benign, cutaneous, chronic inflammatory (autoimmunological) disease. The differentiated vulvar intraepithelial neoplasia (dVIN) accounts for a precursor lesion of vulvar squamous cell carcinoma and is often associated with lichen sclerosus. Although the association between lichen sclerosus and vulvar carcinoma has long been recognized, there is a lack of evidence in literature.

Methods: This retrospective study examined pseudonymized data of 499 women diagnosed with vulvar pathology between 2008 and 2020 at the Department of Gynaecology and Obstetrics of Hannover Medical School (MHH). Data were further stratified for the time of onset, location of disease, accompanying disease, HPV status and progression of disease into vulvar squamous cell carcinoma (VSCC).

Results: In total, 56 patients were diagnosed with vulvar lichen sclerosus. The mean onset of disease was at 60.3 years of age. After subdividing cases of diagnosed LS into those who did not develop vulvar carcinoma in their course and those who did, the ages at onset are 52.66 ± 17.35 and 68.41 ± 10.87, respectively. The incidence of vulvar cancer in women diagnosed with lichen sclerosus was 48.2%. Twenty-five patients reported a diagnosis of VIN in their self-reported history.

Conclusions: In our retrospective study, we showed a trend between vulvar lichen sclerosus and VSCC. The difference between the two age groups of patients diagnosed with lichen sclerosus who developed vulvar carcinoma and those who did not is statistically significant. Our results highlight the importance to diagnose lichen sclerosus early to ensure adequate follow-up and prevent progression to VSCC.

Keywords: Vulvar intraepithelial neoplasia; Vulvar lichen sclerosus; Vulvar squamous cell carcinoma.

Fig. 1

Consort diagram

Fig. 2

The difference between the two age groups at onset of patients diagnosed with lichen sclerosus who developed vulvar carcinoma (w VSCC: with VSCC) and those who did not (w/o VSCC: without VSCC) is statistically significant (p value 0.0213). The standard deviation of the age of patients with lichen sclerosus without VSCC and patients with lichen sclerosus with VSCC is 17.35 and 10.87, respectively

Fig. 3

The mean time between initial diagnosis of lichen sclerosus and VIN amounts to 0.6 years. Considering the time between initial diagnosis of lichen sclerosus and further progression to vulvar carcinoma, the mean value is − 0.3 years