A patient presents with red lesions and white plaques on the vulva with months of intense pruritus. The clinician is concerned for which condition?

A patient presents with red lesions and white plaques on the vulva with months of intense pruritus. The clinician is concerned for which condition?

• A. Vulvar squamous cell carcinoma
• B. Herpes simplex infection
• C. Lichen sclerosus
• D. Condyloma acuminata

Answer: (A)

Chronic vulvar skin disease presenting with white plaques and intense itching is most consistent with lichen sclerosus. This condition itself causes porcelain-white, atrophic plaques and persistent pruritus. Importantly, long-standing lichen sclerosus increases the risk of vulvar squamous cell carcinoma because of ongoing epithelial damage and potential progression to dysplasia over time. So, in this scenario, the clinician’s concern is for vulvar squamous cell carcinoma as a potential malignant transformation arising from the chronic inflammatory condition. By contrast, herpes typically causes painful vesicles or ulcers, not white plaques; condyloma acuminata presents as warty, papillomatous lesions; neither fits the described white plaques with itch as well as the cancer-risk connection.

Chronic vulvar skin disease presenting with white plaques and intense itching is most consistent with lichen sclerosus. This condition itself causes porcelain-white, atrophic plaques and persistent pruritus. Importantly, long-standing lichen sclerosus increases the risk of vulvar squamous cell carcinoma because of ongoing epithelial damage and potential progression to dysplasia over time. So, in this scenario, the clinician’s concern is for vulvar squamous cell carcinoma as a potential malignant transformation arising from the chronic inflammatory condition. By contrast, herpes typically causes painful vesicles or ulcers, not white plaques; condyloma acuminata presents as warty, papillomatous lesions; neither fits the described white plaques with itch as well as the cancer-risk connection.