title: Clinical scoring system to detect malignant and premalignant vulval lesions.
abstract: OBJECTIVE
  To construct a simple clinical scoring system for evaluation of vulval lesions that will be helpful in clinically detecting the premalignant or malignant lesions of vulva.
  
  
  METHODS
  Seventy women referred for vulval examination at a tertiary care centre in north India were examined over a period of 2 years. Biopsy was performed in 66 consenting women. Association of high-grade vulval lesion with various clinical parameters such as age, duration of symptoms, presenting complaints, the presence of depigmentation, ulceration, hyperkeratosis, acetowhite changes on acetic acid application, asymmetrical distribution of the lesion, surface elevation on naked eye or colposcopy, induration on palpation and toluidine blue stain retention was studied. The significantly associated factors were assigned a value of 0 or 1 depending on whether they were present or absent. Score was then formulated for detection of high-grade lesion defined as moderate to severe dysplasia and early malignancy.
  
  
  METHODS
  Histopathology.
  
  
  RESULTS
  Out of the various parameters that were studied, duration of symptoms more than 6 months, hyperkeratosis, asymmetrical distribution of the lesion, surface elevation on naked eye or colposcopy, induration on palpation and positive toluidine blue stain retention of the lesion were found to be significantly associated with a malignant or premalignant lesion. It was found that a score of equal to or greater than 3/6 was significantly associated with a malignant or premalignant lesion.
  
  
  CONCLUSIONS
  This simple scoring system has a potential to identify the high-grade lesions and can be used to identify the vulval lesion requiring a biopsy or further referral to higher centre.
authors.affiliation: Maulana Azad Medical College, Delhi, India ; C-501, Taj Apartments, Gazipur, Delhi, 110017 India.
authors.forename: Shakun
authors.initials: S
authors.lastname: Tyagi
authors.affiliation: Maulana Azad Medical College, Delhi, India.
authors.forename: Reva
authors.initials: R
authors.lastname: Tripathi
authors.affiliation: Maulana Azad Medical College, Delhi, India.
authors.forename: Swaraj
authors.initials: S
authors.lastname: Batra
keywords: Malignancy; Preneoplastic lesion; Score; Vulva