A woman in her 60s presented with a 3-year history of severe vulvar pruritus and more recent localized pain. Prior treatment included emollients and alprazolam. She had a 25-year history of vulvar lichen sclerosus (VLS) thought to be in remission and reported intermittent use of systemic and local hormone replacement therapy for menopause. Physical examination revealed a well-demarcated, friable, indurated, erythematous plaque on the superomedial right labium minus extending to the underside of the clitoral hood (Figure). Mild pallor and waxiness affecting the interlabial creases, labia minora, and clitoral hood, typical of VLS, were also noted. Normal saline wet mount analysis of vaginal discharge demonstrated elevated vaginal pH and decreased vaginal cell maturity consistent with atrophic vaginitis. Punch biopsy of the nodular plaque demonstrated invasive, well-differentiated squamous cell carcinoma.
Sadowsky LM, Schlosser BJ. Vulvar Squamous Cell Carcinoma in a Patient With Vulvar Lichen Sclerosus. JAMA Dermatol. 2019;155(7):844. doi:10.1001/jamadermatol.2019.0323
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