Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover, Germany.
Arch Gynecol Obstet. 2023 Jun;307(6):1921-1928. doi: 10.1007/s00404-022-06848-y. Epub 2022 Nov 21.
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.
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).
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.
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.
硬化性苔藓（LS）是一种良性的、皮肤性的、慢性炎症性（自身免疫性）疾病。分化型外阴上皮内瘤变（dVIN）是外阴鳞状细胞癌的前体病变，常与硬化性苔藓有关。尽管 LS 与外阴癌之间的关联早已被认识，但文献中缺乏证据。
本回顾性研究分析了 2008 年至 2020 年期间在汉诺威医学院妇产科就诊的 499 名诊断为外阴病理学的女性的匿名数据。数据进一步按发病时间、疾病部位、伴随疾病、HPV 状态和疾病进展为外阴鳞状细胞癌（VSCC）进行分层。
共有 56 名患者被诊断为外阴硬化性苔藓。疾病的平均发病年龄为 60.3 岁。将诊断为 LS 的病例分为在病程中未发展为外阴癌的病例和发展为外阴癌的病例后，发病年龄分别为 52.66 ± 17.35 岁和 68.41 ± 10.87 岁。诊断为硬化性苔藓的女性中外阴癌的发病率为 48.2%。25 名患者在自述病史中报告了 VIN 的诊断。
在我们的回顾性研究中，我们发现外阴硬化性苔藓与 VSCC 之间存在趋势。诊断为硬化性苔藓并发展为外阴癌的患者与未发展为外阴癌的患者的两组年龄差异具有统计学意义。我们的结果强调了早期诊断硬化性苔藓的重要性，以确保充分的随访并防止进展为 VSCC。
