by Emily Goebel, MD FRCPC, updated on October 31, 2018
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.
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, untreated lichen sclerosus 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.
This diagnosis is made after a small sample of tissue is removed in a procedure called a biopsy. Lichen sclerosus 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.