Lichen sclerosus - Vulva -

This article will help you read and understand your pathology report for lichen sclerosus of the vulva.

by Emily Goebel, MD FRCPC, updated on October 31, 2018

Quick facts:
  • Lichen sclerosus is an inflammatory condition that affects skin of the vulva.
  • The cause of lichen sclerosus is not known.
  • Patients who have this condition for many years are at risk for developing a pre-cancerous condition called differentiated vulvar intraepithelial neoplasia (dVIN).
The anatomy of the vulva

The vulva is the external part of the female genital tract.  It forms the opening of the vagina and includes the mons pubis, labia majora, labia minora and clitoris. The vulva is composed of skin. The outer surface of the skin is called the epidermis and it is mostly made up of squamous cells. The tissue beneath the epidermis is called the dermis, it contains blood vessels and connective tissue.

skin normal no adenexa

What is lichen sclerosus?

Lichen sclerosus is a non-cancerous chronic inflammatory skin condition. The exact cause is not known. Under the microscope, your pathologist will see changes in the epidermis and dermis of the vulva. The epidermis becomes thin and the squamous cells at the bottom of the epidermis with have clear spaces in them, called vacuoles.  The dermis can appear swollen or homogenized and contains a band of chronic inflammatory cells.

Although lichen sclerosus is a non-cancerous condition, left untreated, this condition can lead to a pre-cancerous disease called differentiated vulvar intraepithelial neoplasia (dVIN). Differentiated vulvar intraepithelial neoplasia is considered a pre-cancerous disease because, over time, it can turn into a cancer called squamous cell carcinoma.

How do pathologists make this diagnosis?

This diagnosis is made after a small sample of tissue is removed in a procedure called a biopsy. This condition is typically treated with topical therapy. Patients are then followed by their doctor and may have additional biopsies of any areas that may be worrisome for dVIN.

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