title: Vulvar cancers in women with vulvar lichen planus: a clinicopathological study.
abstract: BACKGROUND
  Vulvar squamous cell carcinomas (SCCs) arising in association with vulvar lichen planus (LP) are poorly documented.
  
  
  OBJECTIVE
  We sought to present clinicopathological features of 38 patients (median age 61 years, range 39-90 years) with LP-associated vulvar SCCs.
  
  
  METHODS
  Evaluated were location of vulvar SCC and metastases at presentation, recurrences, survival, precursor lesions, presence of human papillomavirus DNA, p16ink4a, and p53 expression.
  
  
  RESULTS
  In all, 32 solitary (5 pT1a, 20 pT1b, 7 pT2) and 6 multifocal SCCs, located in the vestibulum (n=20) and in nonhair-bearing modified and glycogenated mucosa (n=18), arose in erosive (n=13) and nonerosive (n=25) LP. All SCCs were human papillomavirus DNA and p16ink4a negative. Sixteen of 38 (42%) women had inguinal metastases at presentation. Treatment was surgery with clear margins (36/38) and chemoradiation (2/38). Fourteen of 36 (39%) surgically treated patients developed between 1 and 5 new SCCs in the residual diseased mucosa. Of all recurrences, 68% developed within 12 months via precursors revealing various histologic features including elongated, but also flat rete ridges, basaloid and hypertrophic differentiation with inconsistent p53 expression. Fourteen of 38 (37%) patients died of SCCs.
  
  
  CONCLUSIONS
  Retrospective study and lack of a standardized treatment protocols are limitations.
  
  
  CONCLUSIONS
  LP-associated SCCs were located in nonhair-bearing vulvar mucosa. Patients had a high rate of inguinal metastases, recurrent vulvar cancers in diseased mucosa, and disease-related death.
authors.affiliation: Institute of Pathology, Medical University Graz, Graz, Austria. Electronic address: sigrid.regauer@medunigraz.at.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Regauer
authors.affiliation: Department of Gynecology, Medical University Graz, Graz, Austria.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reich
authors.affiliation: General Gynecology Practice, Mürzzuschlag, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Eberz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008010:Lichen Planus / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014845:Vulvar Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy; D014846:Vulvar Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy
keywords: differentiated vulvar intraepithelial neoplasia; human papillomavirus–negative vulvar carcinoma; precursor lesions; vulvar dermatosis; vulvar squamous cell carcinoma