Is vulval erosive lichen planus a premalignant condition?

A 58-year-old woman presented to the Vulval Dermatology Clinic with a 4-month history of vulval burning and irritation. Her quality of life was significantly affected: she reported pain while urinating, was unable to wear certain clothing, and experienced dyspareunia. Treatment for thrush using over-the-counter medications had resulted in worsening symptoms. Examination showed tender erythematous erosions with a white border, located at the vaginal introitus. These lesions were tender. Inspection of the oral cavity revealed bilateral lacy white plaques on the buccal mucosa. The oral lesions were asymptomatic. Biopsy from the edge of a vulval erosion was in keeping with the clinical diagnosis of erosive lichen planus. The patient was counseled about the possible risk of squamous cell carcinoma (SCC) of the vulva, which is associated with the condition. She asked about the magnitude of that risk, but we were unable to give an exact figure. This prompted our review of the literature. Erosive lichen planus is an uncommon, chronic inflammatory condition mainly affecting the mucosal surfaces of the mouth and genitalia. It is thought to be an autoimmune disorder with T cell–mediated damage to basal keratinocytes. Vulval erosive lichen planus (ELPV) causes painful erosions and scarring of the vulva and vagina. Some researchers have postulated on the basis of case reports that ELPV lesions may develop into SCC. However, ELPV is underresearched and evidence from larger-scale studies is lacking. This critically appraised topic aims to evaluate the evidence to determine whether ELPV is associated with an increased risk of vulval SCC.