Vulval lichen sclerosus — SCE Dermatology MCQ

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HardGenito-urinary disorders and oral medicineVulval lichen sclerosusSCE Dermatology

A 67-year-old woman has vulval itch, dyspareunia and soreness. Examination shows porcelain-white atrophic plaques with fissuring and loss of labia minora architecture. There is a new persistent hyperkeratotic tender area on one plaque. What is the most important differential to exclude?

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Correct answer: A — Vulval squamous cell carcinoma

The best answer is “Vulval squamous cell carcinoma”. Genital lichen sclerosus causes pruritic porcelain-white atrophy and architectural change; persistent focal thickening, erosion, ulceration or tenderness requires assessment for differentiated VIN or squamous carcinoma. The alternatives “Candida albicans infection”, “Genital psoriasis”, “Herpes simplex infection”, “Irritant contact dermatitis” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: BAD lichen sclerosus information: https://www.bad.org.uk/pils/lichen-sclerosus-in-females