A 68-year-old woman has a white, porcelain-like plaque on the vulva with a parchment-thin epidermis. Biopsy shows marked dermal collagen homogenization with loss of elastic fibers and a thin atrophic epithelium. She is counseled about her long-term risk. Which statement is correct?

• A It is HPV driven and progresses to usual-type vulvar intraepithelial neoplasia in up to half of cases
• B It is purely inflammatory with no malignant potential and requires no follow-up
• C It carries a small risk of progression to squamous cell carcinoma and is associated with HPV-independent, p53-mutant carcinogenesis ✓
• D It is premalignant for melanoma via chronic irritation of melanocytes

Explanation

Lichen sclerosus is a chronic inflammatory dermatosis with a small but real risk of progression to squamous cell carcinoma. HPV-independent vulvar squamous cancers arising on a background of lichen sclerosus often pass through differentiated VIN (dVIN) and harbor TP53 mutations, contrasting with HPV-driven usual-type VIN that affects younger women and shows p16 block positivity. While the absolute risk of malignancy is low, requiring surveillance rather than reassurance alone, option B understates the risk, and options A and D invoke wrong pathways.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.