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Dermatology/please help me interpret

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QUESTION: Please interpret this biopsy result.  I have had lichen sclerosis for 25 years. Squamous hyperplasia, hyperkeratosis and focal squamous atypia. Focal vin can not be excluded. Ki-67/p16 stains performed with appropriate controls. P16 is negative and Ki-67 shows mild increase in cell proliferation.
How does the success rate of imiquimod 5% for differentiated (VIN) compare to surgical intervention?  What are the pros and cons of both treatments?

ANSWER: Have you had genital warts as that can cause VIN. I would first try imiquimod because it had been shown to be effective. If that does not work which I doibt, the next treatment would be MOHS surgery because the doctor checks the margins while you are in the office so you know the lesion is gone when you leave.

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QUESTION: I never had warts and tested negative for HPV.  Longstanding lichen sclerosis increases my chances of VIN/cancer.   I have had 5 biopsies over the years. They have always been consistent with lichen sclerosis. This is the first time it showed atypia. Why would the white patches suddenly change?

Answer
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy and scarring. Lichen sclerosus has both genital and extragenital presentations and also goes by the names lichen sclerosus et atrophicus (dermatological literature), balanitis xerotica obliterans (glans penis presentation), and kraurosis vulvae (older description of vulvar presentation). An increased risk of squamous cell carcinoma may exist in genital disease, but the precise increase in risk and what cofactors (human papillomavirus infection or prior radiotherapy) may be involved are not yet completely defined. In large series, genital presentations, both vulvar and penile, outnumber extragenital reports by more than 5:1.

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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