What percentage of women with lichen sclerosus develop vulval cancer and do any management options decrease this risk?
The risk of women with lichen sclerosus et atrophicus developing vulval cancer is between 4 and 6%, but over many years. Cancers can arise in asymptomatic cases and it is not known whether treatment can affect this incidence or modify the risk. Awareness of changes in the vulva and change of symptoms, in particular the formation of hyperkeratotic plaques or erosions that do not respond to treatment, should arouse suspicion. Biopsy is indicated. There is no indication for surgery and simple steroid application to control symptoms does not appear to increase or decrease the risk of developing cancer. Follow-up after diagnosis is recommended six-monthly or annually, but because of the long-term potential risk of disease this becomes impractical, so patient information leaflets and self-help are very important. Most gynaecology departments that deal with vulval pathology can provide such a leaflet to patients who then know what changes to report to their doctor. 8 Apart from lower abdomina
