Lichen Sclerosus Tied to Higher Vulvar Cancer Risk

TOPLINE:

A study of 2.5 million women aged 65 years or older found a 0.7% prevalence of vulvar lichen sclerosus (VLS), and those with VLS had an 11-fold higher risk of developing vulvar squamous cell carcinoma or carcinoma in situ (VcSCC or VcSCCis).

METHODOLOGY:

• Analysis included 2,525,340 women aged 65 years or older (mean age, 73 years; 84% White, 6% Black) with continuous Parts A, B, and D fee-for-service Medicare enrollment from October 2015 through December 2021.
• Outcomes were VLS prevalence and treatment patterns.
• Vulvar cutaneous squamous cell carcinoma or in situ was also reported.

TAKEAWAY:

• The prevalence of VLS was 0.7% (n = 17,987; 93.5% were White); 72.6% of these patients received appropriate treatment with topical corticosteroids or calcineurin inhibitors (which reduces the risk for VcSCC).
• Of the 47,499 VLS encounters, obstetrician-gynecologists managed 56.1%, while dermatologists managed 19.5% of cases.
• Of all patients with VLS, 1.2% (n = 162) subsequently developed VcSCC or VcSCCis; the risk for these two diagnoses was significantly higher than the risk in patients without VLS (hazard ratio, 11.81; 95% CI, 11.62-12.02).
• Most patients with VcSCC or VcSCCis (80.9%) received nontissue-sparing treatments, and only one underwent Mohs micrographic surgery.

IN PRACTICE:

“The 0.7% VLS prevalence in female Medicare beneficiaries is higher than the 0.05% prevalence in younger women and likely an underestimation, as VLS’s sensitive nature and healthcare access issues may prevent diagnosis,” the study authors noted. In an accompanying editorial, Kelly H. Tyler, MD, of the Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, wrote that dermatologists “are uniquely positioned to participate in the multidisciplinary management of patients with LS and vulvar cSCC and should advocate for this underserved patient population.”

SOURCE:

The study was led by Surya A. Veerabagu, MD, of The University of New Mexico in Albuquerque, New Mexico, and was published online on July 23 in JAMA Dermatology.

LIMITATIONS:

The study’s generalizability is limited by its focus on Medicare beneficiaries aged 65 years or older, although VLS may be common in this population. Reliance on disease and treatment codes could have introduced errors.

DISCLOSURES:

This research was supported by grants from the Cancer Prevention and Research Institute of Texas and the National Cancer Institute. Two study authors reported receiving grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and serving as treasurer of the Vulvar Dermatoses Research Consortium, the American College of Mohs Surgery Board of Directors, the American Society for Dermatologic Surgery Board of Directors, the National Comprehensive Cancer Network Non-Melanoma Skin Cancer Guideline Panel, and the High-Risk Squamous Cell Carcinoma Multicenter Collaborative. Tyler reported having no disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.