Fewer Cancer Recurrences Seen With Topical Corticosteroids in Vulvar Lichen Sclerosus

By David Douglas

May 20, 2020

NEW YORK (Reuters Health) - Topical corticosteroids use is associated with a reduced recurrence rate of vulvar squamous cell carcinoma (vSCC) and differentiated vulvar intraepithelial neoplasia (dVIN) in women with vulvar lichen sclerosus, according to researchers in Australia.

"Topical corticosteroids are not routinely prescribed following surgical treatment of a malignant or pre-malignant lesion associated with vulval lichen sclerosus," said Dr. Simone Chin of the University of New South Wales, in Darlington.

"Although further studies are needed, with the use of topical corticosteroids being safe and inexpensive, we hope that these results prompt clinicians to consider routinely adding topical corticosteroids to their management of vulval lichen sclerosus after surgical management of malignant and pre-malignant lesions," she told Reuters Health by email.

Untreated vulvar lichen sclerosus can increase the lifetime risk of vSCC and dVIN by as much 7%, Dr. Chin and her colleagues note in JAMA Dermatology. While suppressive corticosteroid treatment can lower this risk, it is not known whether it also has an effect on recurrence rates, which have been estimated at around 45%, the researchers note.

To investigate, they examined data on 2,410 patients with vulvar lichen sclerosus. The database employed was set up in 2008 and patients remain under surveillance.

All were treated with topical corticosteroids after primary excision of vSCC or dVIN. Among agents used were betamethasone dipropionate, hydrocortisone and desonide.

The researchers identified 25 patients who had previous vSCC and/or dVIN. However, 10 patients with human papillomavirus (HPV)-associated dVIN or HPV-associated vSCC were excluded from analysis. One patient who was not adherent and three who were lost to follow-up were also excluded.

Of the 11 remaining patients, eight remained recurrence-free at a mean follow-up of 10.5 years. Two had vSCC recurrence and the remaining patient had dVIN recurrence.

Thus, say the researchers, patients who adhered to topical corticosteroid therapy had a vSCC or VIN recurrence rate of 27% compared with reported five-year recurrence rates of 44% to 47%. Only one patient with recurrence had subsequent recurrence compared to a reported 80% in those untreated.

The researchers concede that their study is a single-center retrospective review with a small sample size and no control group.

Dr. Andrew T. Goldstein of The Center for Vulvovaginal Disorders, in Washington, D.C., who was not involved in the research, told Reuters Health by email, "Though there are important limitations outlined in this study it reaffirms the importance of consistent and long-term treatment with corticosteroids for lichen sclerosus."

SOURCE: https://bit.ly/3dOciGe JAMA Dermatology, online May 6, 2020.