Is Lichen Sclerosus Precancerous?
Lichen sclerosus is precancerous. Lichen sclerosus is a rare chronic inflammatory condition that has a tendency to progress to malignancy. It is characteristic of itchy white plaques leading to thinning of the involved skin. The skin of any part of the body can be affected, but it most commonly affects genitals and anal area. Other body parts that can be affected are extremities and trunk region.
Lichen sclerosus affects individuals of any age, but is most common in the fifth decade of life and in women around perimenopause. It is 10 times more prevalent in females than in males with Caucasian ethnicity.
Does Lichen Sclerosus Lead to Cancer?
Lichen sclerosus has been associated with anogenital squamous cell carcinoma and verrucous carcinoma. Studies have also demonstrated tumor promoting molecular changes in relation to lichen sclerosus that might explain the malignant potential of this condition. Lichen sclerosus along with human papilloma virus (HPV) has also been linked to vulval and penile neoplasias and these have been found to be the two most common causes of cancer.
Although the incidence of vulvar cancer is quite low, 50 to 70% of squamous cell vulvar cancers have a known history of lichen sclerosus. Currently, there is no diagnostic tool that will differentiate between lichen sclerosus that will continue to stay benign versus lichen sclerosus with a potential of developing into squamous cell carcinoma.
Nevertheless, p53 and MIB1 monoclonal antibody have shown promise in retrospective studies, further testing and research is required to find confirmatory biomarkers that will relate to cancer progression. The current gold standard for cancer screening is still biopsy for suspicious and dysplastic lesions.
Treatment of lichen sclerosus is with topical steroids, phototherapy and immune modulating drugs, in some cases; it might even require surgery to remove the atrophied or scarred tissue if it is too severe. The dysplastic tissue should be monitored for change as lichen sclerosus has been associated with secondary epithelial dysplasia and in 4% of cases with squamous cell carcinoma.
What is The Cause of Lichen Sclerosus?
The etiology of lichen sclerosus is still unknown; however, following risk factors have been implicated in the pathogenesis of lichen sclerosus. Hormonal imbalance has been linked to this condition as this condition is seen in perimenopausal period and postmenopausal women when estrogen levels begin to decrease. It has also been linked to overactive immune system such as in thyroid disease along with positive family history of lichen sclerosus and environmental factors, infections and trauma.
The disease is less common in males and when present they are more commonly found in uncircumcised penile area as compared to circumcised penis, which has been linked to clogging of urine under the foreskin. Around 10% of cases have also been noted in children under the age of 7 years, which is also more common in girls than boys. This condition is not contagious, nor even through sexual contact.
What Are The Symptoms of Lichen Sclerosus?
Lichen sclerosus mostly affects genital and anal areas including vagina, vulva, anus in women and penis in males, often forming figure of eight configuration. The symptoms of lichen sclerosus may range from mild to severe, wherein, mild cases are usually symptom less. There are few cases of severe lichen sclerosus, which is characteristic of mild to severe itching with white plaques that might be wrinkled or parched and “porcelain white” in appearance. If left untreated, it may evolve into a scar causing dyspareunia (painful sexual intercourse). Non-genital lesions are rare and when present they occur in trunk or extremities. In chronic lesions, when there is severe itching, it may lead to scratching, skin tear, blistering and ulceration. In chronic and severe cases, it may even lead to obliteration of labia minora and clitoris and phimosis in males along with atrophy and narrowing of vagina and urethral stenosis. In some individuals symptoms may resolve spontaneously without any management; however, it has a greater chance of recurrence.
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