Risk of Vulvar Cancer in Lichen Sclerosus
VLS is associated with an increased risk of vulvar carcinoma. This is information every patient should know—not to cause alarm, but to understand why regular follow-up with a specialist is not optional.
What relationship exists between VLS and vulvar carcinoma
Vulvar lichen sclerosus is recognized as a risk factor for the development of vulvar squamous cell carcinoma (VSCC). This association is documented in clinical literature and recognized by major international guidelines, including the ISSVD, BAD, and EADV.
The exact mechanism by which VLS increases the risk of malignancy is not completely established. The most widely accepted hypothesis is that chronic inflammation of vulvar tissue, sustained over years, can induce changes in the DNA of epithelial cells that favor malignant transformation.
What is the actual risk?
Available studies estimate that the risk of vulvar carcinoma in patients with VLS ranges between 3% and 5% over a lifetime. This percentage is significantly higher than in the general population, but in absolute terms it means that the vast majority of women with VLS will not develop vulvar carcinoma.
What these data clearly indicate is that regular clinical follow-up is essential—not because cancer is inevitable, but because early detection of any suspicious change is the most effective way to address it.
What changes should alert the patient and the specialist
In VLS follow-up, the specialist actively looks for signs that may indicate a change toward dysplasia or malignancy. The patient should also be aware of them to consult without delay if observed:
> Persistent erythematous lesions—reddish areas that do not respond to corticosteroid treatment and persist in successive examinations
> Indurated or thickened lesions—areas with a different consistency from surrounding tissue, palpable as firmer or nodular
> Non-healing ulcers—erosions or ulcers that do not respond to usual treatment within a reasonable timeframe
> Pigmentary changes—appearance of dark, brownish, or irregularly pigmented areas in the context of VLS
> Bleeding unrelated to fissures—spontaneous bleeding not explained by known active fissures
Any of these findings should prompt urgent evaluation with the specialist, who will assess the indication for targeted biopsy.
Why regular follow-up is the best protection
Regular clinical follow-up in patients with VLS has a dual objective: to assess disease control and to detect any suspicious change early.
International clinical guidelines—ISSVD, BAD 2018, EADV 2024—recommend periodic follow-up for all patients with VLS, regardless of whether the disease is well controlled. The frequency of examinations depends on individual clinical circumstances, but generally at least one annual examination is recommended.
Well-controlled VLS with appropriate treatment has a significantly lower risk of malignancy than untreated VLS or VLS with irregular treatment. Correct treatment of VLS is not only for symptom control: it is also a measure to reduce the risk of malignancy.
Information that protects, not that alarms
The risk of vulvar cancer associated with VLS is real, and concealing or minimizing it does not help any patient. But it is also not useful to exaggerate it or present it in a way that generates disproportionate distress.
The reality is this: VLS is a chronic disease that requires ongoing follow-up and treatment. Regular follow-up with a specialist allows detection of any suspicious change at a very early stage, when management is simpler and outcomes are better. That follow-up is the most effective protection tool available.