Lichen sclerosus (LS) and lichen planus (LP) are two skin conditions which can affect the vulva. Occasionally they may develop into cancer after many years. Only about 1 in 25 women with LS or LP will develop a vulval cancer.
LS and LP are fairly common, non-cancerous skin conditions, which can occur in the skin on any part of the body. They can affect children as well as adults. These changes are not cancer, but in a few people they may, over many years, develop into a type of skin cancer known as squamous cell cancer. Vulval LS and LP are slowly developing, inflammations of the skin in the vulval. They can be controlled by treatment, but cannot be cured.
The causes of LS and LP are not known, but they are more common in older women. It is not possible to get LS or LP through sexual intercourse: neither are sexually transmitted diseases and they are not infectious.
When LS or LP develop the skin in the affected areas becomes very itchy and sore, with an abnormal appearance and a change in colour. The skin becomes more fragile than normal skin and may split, causing stinging and pain. The vulva may become distorted, causing a change in the shape or size. Occasionally this leads to difficulties with passing urine or having sexual intercourse. The vagina may become narrowed and sexual intercourse may become uncomfortable. The symptoms vary from woman to woman. In some women with these conditions there are no symptoms at all and the condition may be discovered during medical examinations for other health problems.
As the signs and symptoms of LS and LP can vary and are often similar to other conditions affecting the skin of the vulva, it is necessary to take a small sample of cells from the affected area to examine under a microscope in order to make the diagnosis. This test is known as a biopsy and is done in the out-patient department. An anaesthetic cream is usually used to numb the vulval area before the biopsy is taken and it takes 20 minutes to work. Local anaesthetic is then injected into the area, using a small needle. Sometimes a general anaesthetic may be given. A sample of cells (about the size of a peppercorn) is then taken from the vulva.
Treatment for LS and LP depends on the severity of the symptoms. Often no treatment will be needed but if you have troublesome symptoms it can help to use a non-perfumed moisturiser instead soap in the vulval area. Also a steroid ointment (clobetasol proprionate called Dermovate) can be prescribed by your doctor and is used twice a day for 3 months. After this your doctor may recommend using the cream twice a week. This can safely control symptoms allowing women to go back to a normal life but doesn’t get rid of the condition completely. Also this treatment can make the skin more supple so intercourse is easier.
Rarely, the lichen sclerosus or lichen planus can cause a skin ulcer or sore which does not heal and laser surgery may then be used to remove the affected areas of skin. The laser surgery is usually done in the outpatients clinic. Your doctor can tell you how much skin will need to be removed and how this may affect you. It is important to discuss this with your specialist (gynaecologist) before you have the treatment.
As LS and LP are long term conditions which cannot be completely cured, you will be seen by your specialist regularly for check ups. Women who have had either of these conditions for many years have a small risk of developing a vulval cancer. This usually occurs in women in their 60's to 90's rather than in younger women. So it is important to see your doctor or nurse regularly to check for any signs of a cancer developing so that treatment can be given at an early stage, when there is a high chance of cure.