Should We Always Biopsy in Clinically Evident Lichen Sclerosus?

Abstract

Objective The aims of the study were to review cases of clinically diagnosed lichen sclerosus (LS) and to compare the histological features found on biopsy to clinical features seen on examination. Methods A retrospective chart review was undertaken of patients attending a specialist vulval service between 2013 and 2015 with a clinical diagnosis of LS. Patients in whom there was clinical diagnostic uncertainty or those with features of lichen planus or lichen planus/LS overlap were excluded. We determined the proportion of these patients who underwent vulval biopsy and reviewed their histology. Results One hundred fifteen charts were reviewed. Sixty-nine (69/115, 60%) had a firm diagnosis of established LS, and of these, 39 (39/69, 56.5%) had a biopsy performed in the previous 5 years. Thirteen (13/39, 33.3%) of these biopsies fell short of a diagnosis of LS histologically with some suggestive but nondiagnostic and some showing nonspecific features. Conclusions Reliance on biopsies solely to establish or exclude the diagnosis of LS is inadvisable. A good level of knowledge of the characteristic clinical features is imperative among gynecologists, dermatologists, and general practitioners.

Balanopreputial sac and urine microbiota in patients with male genital lichen sclerosus

“…The diagnosis of MGLSc was based on clinical features, and histopathology was not sought to confirm the diagnosis. There has been historical discussion regarding the role of biopsy in the diagnosis of LSc; the literature indicates that histology may be nonspecific and falsely negative, and reliance on histology can lead to delayed diagnosis and progression of the disease 53,54 . For these reasons, histopathology was not sought in this study.…”

<p>Vulvar Lichen Sclerosus: Current Perspectives</p>

“…12 In a retrospective review of almost 70 cases of patients with clinically diagnosed LS who had a vulvar biopsy performed within 5 years, one-third of biopsies did not meet histological criteria for diagnosis of LS. 45 Early LS may be histologically misdiagnosed as eczema or "nonspecific vulvitis." 46,47 While classic histologic findings may confirm the diagnosis, a nonspecific biopsy should not rule out clinically suspected LS.…”

“…46,47 While classic histologic findings may confirm the diagnosis, a nonspecific biopsy should not rule out clinically suspected LS. 45,48…”

Microablative fractional radiofrequency as a therapeutic option for vulvar lichen sclerosus: a pilot study

“…The main symptoms are pruritus, especially at night, followed by pelvic pain, dyspareunia, and burning sensation. These symptoms may affect sexual activity and contribute to the high prevalence of sexual dysfunction in these patients (7)(8)(9)(10)(11)(12).…”

“…There is some evidence that women with a recent diagnosis of VLS respond better to treatment (7,(13)(14)(15). However, corticosteroids should be used in the lowest amounts and frequency, and for the shortest period needed to promote clinical improvement, owing to their adverse effects (7)(8)(9)(10)(11)(12)(13). In addition, corticosteroids inhibit fibroblast proliferation and reduce collagen production, which are harmful for the vulva.…”