Scurry J.
Pathology, Mercy Hospital for Women, Melbourne, Victoria, Australia.
Int J Gynecol Cancer. 1999 Mar;9(2):89-97. doi: 10.1046/j.1525-1438.1999.99016.x.
In the past decade, two types of vulvar squamous cell carcinoma (SCC) have been delineated, Human papillomavirus (HPV) positive and negative. Clinicopathologic, virologic, cytomorphometric, and genetic differences support the view that these two types of carcinoma are fundamentally different and that HPV-negative carcinoma is not simply carcinoma where viral DNA has not been able to be identified. The traditional view of HPV-negative carcinoma is that it is caused by chronic tissue damage from itching and scratching. However, itching and scratching alone do not explain the close association of carcinoma with lichen sclerosus, nor the absence of such an association with other itchy conditions such as eczema or psoriasis. These observations point to a role for lichen sclerosus in the pathogenesis of vulvar carcinoma. Most observations about the etiology of lichen sclerosus can be grouped into its immunogenetic or genital predisposition, or the Köbner phenomenon. In the itch-scratch-lichen sclerosus hypothesis, lichen sclerosus is postulated to occur as a Köbner phenomenon in women with the susceptible immunophenotype who scratch because of genital irritants such as urine, vaginal secretions and smegma, and psychological factors. Lichen sclerosus, itself a very itchy condition, contributes to a vicious cycle of itching and scratching which leads to superimposed lichen simplex chronicus, squamous cell hyperplasia, and ultimately carcinoma. The itch-scratch-lichen sclerosus hypothesis reconciles the traditional itch-scratch hypothesis with the strong clinicopathologic association of lichen sclerosus with carcinoma.
在过去十年中，已明确了两种类型的外阴鳞状细胞癌（SCC），即人乳头瘤病毒（HPV）阳性和阴性。临床病理、病毒学、细胞形态计量学及遗传学差异均支持这两种类型的癌本质上不同，且HPV阴性癌并非仅仅是未能鉴定出病毒DNA的癌这一观点。关于HPV阴性癌的传统观点认为，它是由瘙痒和搔抓引起的慢性组织损伤所致。然而，单纯的瘙痒和搔抓并不能解释癌与硬化性苔藓的密切关联，也无法解释其与其他瘙痒性疾病（如湿疹或银屑病）缺乏这种关联的原因。这些观察结果表明硬化性苔藓在外阴癌的发病机制中起作用。关于硬化性苔藓病因的大多数观察结果可分为免疫遗传学或生殖器易感性，或同形反应现象。在瘙痒-搔抓-硬化性苔藓假说中，假定硬化性苔藓是在具有易感免疫表型的女性中作为同形反应现象出现的，这些女性因尿液、阴道分泌物和包皮垢等生殖器刺激物以及心理因素而搔抓。硬化性苔藓本身就是一种非常瘙痒的疾病，会导致瘙痒和搔抓的恶性循环，进而导致叠加的慢性单纯性苔藓、鳞状细胞增生，最终发展为癌。瘙痒-搔抓-硬化性苔藓假说将传统的瘙痒-搔抓假说与硬化性苔藓与癌之间强大的临床病理关联协调了起来。
