Lichen sclerosus (LS) has a known association with the development of squamous cell carcinoma of the vulva. The purpose of this study was to investigate molecular markers, which could indicate premalignant changes. Multiple sequential vulvar biopsies were taken over a period of 11 years from a patient with longstanding LS. Immunohistochemical staining was used to demonstrate a range of molecular markers. Increased expression of p53 and Ki67 was found in areas of squamous hyperplasia (SH) and differentiated vulvar intraepithelial neoplasia (dVIN) which correlated with the subsequent development of invasive squamous cell carcinoma (SCC). Molecular changes have been found to accompany histologic changes in the progression of vulvar LS to malignancy. Such markers may prove a useful addition in the clinical management of these conditions.

Am J Obstet Gynecol 1999;181(1):99–102 A pilot study investigates the vulvar algesiometer in correlating symptom improvement with treatment response in vulvar vestibulitis syndrome. Women with vulvar vestibulitis syndrome attending a specialist vulvar clinic were assessed with the algesiometer before and after treatment. The conditions of 25 patients had improved to the point of discharge. Readings before and after treatment were compared. There was statistically significant difference in the vulvar algesiometer readings before and after treatment and this improvement was reflected in patient response. Nine patients had no response to treatment and also no significant improvement in vulvar algesiometer score. The vulvar algesiometer provides an easy noninvasive means of assessing vestibular tenderness. It is well tolerated by the patients and provides a degree of biofeedback for them. Editorial Comment: The understanding of vulvar vestibulitis has been hampered by the subjective nature of the clinical syndrome. Importantly, this new technique is a quantitative method for assessing vulvar pain on vestibular touch. It is a noninvasive method of assessing the quantified vestibular tone to assess response to treatment. It should be simple to use and gives recorded results, which may be important in long‐term assessment of treated patients. (LBT)