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Genital Lichen Planus — SCE Dermatology MCQ

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HardGenital DermatologyGenital Lichen PlanusSCE Dermatology

A woman with vulval lichen sclerosus treated with ultrapotent topical corticosteroid develops a persistent hyperkeratotic plaque with focal erosion. What is the next step?

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Correct answer: E — Biopsy the plaque to exclude differentiated VIN or invasive SCC

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

A is correct. Persistent focal hyperkeratosis, erosion, erythema, a papule or nodule, or an area resistant to adequate topical corticosteroid treatment in genital lichen sclerosus requires biopsy. The aim is to identify differentiated vulval intraepithelial neoplasia or invasive SCC early. Background disease still needs correct ultrapotent topical corticosteroid maintenance and surveillance, but escalating treatment without sampling a suspicious focal change can delay cancer diagnosis. Candidiasis and contact irritation may coexist, yet neither should be assumed to explain a persistent hyperkeratotic erosion.

Reference: British Association of Dermatologists guideline for lichen sclerosus: https://doi.org/10.1111/bjd.16241