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Should We Always Biopsy in Clinically Evident Lichen Sclerosus?

McCarthy, Siobhan, MB, BCh, BAO1; MacEoin, Neil, MB, BCh, BAO1; O'Driscoll, Michael, MB, BCh, BAO1; O'Connor, Roisin, MB, BCh, BaO, MRCPI1; Heffron, Cynthia C.B.B., MD, PhD, FRCPath2; Murphy, Michelle, MB, MRCPI1

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 182–183
doi: 10.1097/LGT.0000000000000457
Benign Vulvovaginal Disorders

The aims of the study were to review cases of clinically diagnosed lichen sclerosus (LS) and to compare the histological features found on biopsy to clinical features seen on examination.

Methods A retrospective chart review was undertaken of patients attending a specialist vulval service between 2013 and 2015 with a clinical diagnosis of LS. Patients in whom there was clinical diagnostic uncertainty or those with features of lichen planus or lichen planus/LS overlap were excluded. We determined the proportion of these patients who underwent vulval biopsy and reviewed their histology.

Results One hundred fifteen charts were reviewed. Sixty-nine (69/115, 60%) had a firm diagnosis of established LS, and of these, 39 (39/69, 56.5%) had a biopsy performed in the previous 5 years. Thirteen (13/39, 33.3%) of these biopsies fell short of a diagnosis of LS histologically with some suggestive but nondiagnostic and some showing nonspecific features.

Conclusions Reliance on biopsies solely to establish or exclude the diagnosis of LS is inadvisable. A good level of knowledge of the characteristic clinical features is imperative among gynecologists, dermatologists, and general practitioners.

1Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland; and

2Department of Histopathology, Cork University Hospital, Cork, Ireland

Correspondence to: Siobhan McCarthy, MB, BCh, BAO, South Infirmary Victoria University Hospital, Old Blackrock Rd, Cork, Ireland. E-mail:

The authors have declared they have no conflicts of interest.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology