Aragón Health Research Institute, Zaragoza, Spain.
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA.
J Low Genit Tract Dis. 2022 Jul 1;26(3):250-257. doi: 10.1097/LGT.0000000000000673. Epub 2022 Mar 11.
Vulvar lichen sclerosus (VLS) and possibly vulvar lichen planus (VLP) are associated with an increased vulvar cancer (VC) risk. We analyzed the risk of VC and its precursors after a diagnosis of VLS or VLP.
A search was performed to identify articles describing the development of vulvar neoplasia in women with VLS or VLP. This systematic review was registered with the PROSPERO database.
Fourteen studies on VLS included 14,030 women without a history of vulvar neoplasia. Vulvar cancer, differentiated vulvar intraepithelial neoplasia (dVIN), and vulvar high-grade squamous intraepithelial lesion occurred in 2.2% (314/14,030), 1.2% (50/4,175), and 0.4% (2/460), respectively. Considering women with previous or current VC, the rate was 4.0% (580/14,372). In one study, dVIN preceded VC in 52.0% of the cases. Progression of dVIN to VC was 18.1% (2/11).The risk was significantly higher in the first 1-3 years after a biopsy of VLS and with advancing age; it significantly decreased with ultrapotent topical steroid use.For the 14,268 women with VLP (8 studies), the rates of VC, dVIN, and vulvar high-grade squamous intraepithelial lesion were 0.3% (38/14,268), 2.5% (17/689), and 1.4% (10/711), respectively.
Vulvar lichen sclerosus is associated with an increased risk of VC, especially in the presence of dVIN and with advancing age. Ultrapotent topical steroids seem to reduce this risk. An increased risk of developing VC has been suggested for VLP. Hence, treatment and regular life-long follow-up should be offered to women with VLS or VLP.
外阴硬化性苔藓（VLS）和可能的外阴扁平苔藓（VLP）与外阴癌（VC）风险增加有关。我们分析了 VLS 或 VLP 诊断后 VC 及其前体的风险。
进行了一项搜索，以确定描述 VLS 或 VLP 女性外阴新生物发展的文章。本系统评价已在 PROSPERO 数据库中注册。
有 14 项关于 VLS 的研究纳入了 14030 名无外阴肿瘤病史的女性。VLS 患者中发生了外阴癌、分化型外阴上皮内瘤变（dVIN）和外阴高级别鳞状上皮内病变，分别为 2.2%（314/14030）、1.2%（50/4175）和 0.4%（2/460）。考虑到有或当前有 VC 的女性，这一比例为 4.0%（580/14372）。在一项研究中，dVIN 在 52.0%的病例中先于 VC 发生。dVIN 进展为 VC 的比例为 18.1%（2/11）。在 VLS 活检后的 1-3 年内和随着年龄的增长，风险显著增加；随着超强效局部类固醇的使用，风险显著降低。对于 14268 名患有 VLP（8 项研究）的女性，VC、dVIN 和外阴高级别鳞状上皮内病变的发生率分别为 0.3%（38/14268）、2.5%（17/689）和 1.4%（10/711）。
外阴硬化性苔藓与 VC 风险增加有关，尤其是在存在 dVIN 和年龄增长的情况下。超强效局部类固醇似乎降低了这种风险。VLP 发生 VC 的风险增加。因此，应向 VLS 或 VLP 女性提供治疗和终生定期随访。
