title: Vulvar Lichen Sclerosus and Neoplastic Transformation: A Retrospective Study of 976 Cases.
abstract: OBJECTIVE
  The aim of the study was to estimate the neoplastic potential of vulvar lichen sclerosus (VLS).
  
  
  METHODS
  This was a retrospective study of 976 women with VLS. We recorded age at diagnosis of VLS, length of follow-up, and type of neoplasia, categorized as the following: (1) vulvar intraepithelial neoplasia (VIN), further subdivided in differentiated VIN (dVIN) and high-grade squamous intraepithelial lesion; (2) superficially invasive squamous cell carcinoma; and (3) frankly invasive squamous cell carcinoma. Neoplasia incidence risk, neoplasia incidence rate, and cumulative probability of progression to neoplasia according to the Kaplan-Meier method were estimated. Log-rank test was used to compare the progression-free survival curves by age at diagnosis of VLS.
  
  
  RESULTS
  The mean age at diagnosis of VLS was 60 (median = 60; range = 8-91) years. The mean length of follow-up was 52 (median = 21; range = 1-331) months. The following 34 patients developed a neoplasia: 8 VIN (4 dVIN, 4 high-grade squamous intraepithelial lesions), 6 keratinizing superficially invasive squamous cell carcinoma (5 with adjacent dVIN), and 20 keratinizing invasive squamous cell carcinoma (1 with adjacent dVIN). The neoplasia incidence risk was 3.5%. The neoplasia incidence rate was 8.1 per 1,000 person-years. The cumulative probability of progression to neoplasia increased from 1.2% at 24 months to 36.8% at 300 months. The median progression-free survival was significantly shorter in older women (≥70 years) when compared with that in younger women (p = .003).
  
  
  CONCLUSIONS
  Vulvar lichen sclerosus has a nonnegligible risk of neoplastic transformation and requires a careful and lifelong follow-up in all patients, particularly in elderly women. Early clinical and histological detection of preinvasive lesions is essential to reduce the risk of vulvar cancer.
authors.affiliation: 1Department of Gynecology and Obstetrics, University of Torino, Torino; 2Preventive Gynecology Unit, European Institute of Oncology, Milan; and 3Pathology Unit, S. Anna Hospital of Torino, Torino, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Micheletti
authors.forename: Mario
authors.initials: M
authors.lastname: Preti
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Radici
authors.forename: Sara
authors.initials: S
authors.lastname: Boveri
authors.forename: Orazio
authors.initials: O
authors.lastname: Di Pumpo
authors.forename: Sebastiana S
authors.initials: SS
authors.lastname: Privitera
authors.forename: Bruno
authors.initials: B
authors.lastname: Ghiringhello
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D002648:Child; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D007724:Vulvar Lichen Sclerosus / Q000150:complications* / Q000473:pathology*; D014846:Vulvar Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D055815:Young Adult