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Question answered:30/04/08
In 2002 the British Association of Dermatologists published a guideline on lichen sclerosus [1], with regard to follow-up, it reports:
“The risk of malignancy in uncomplicated genital LS that has been diagnosed and treated appropriately is very small. If malignancy occurs it does so rapidly. Early detection would require 3-monthly follow-up consultations; this is generally impossible in the U.K. due to the constraints of the National Health Service system.
The authors suggest two follow-up visits after the initial consultation: (i) at 3 months to assess response to treatment and to ensure that the patient is using the topical corticosteroid appropriately and judiciously, and (ii) if response has been satisfactory, a final assessment 6 months later to ensure that the patient is confident in treating their problem and to take the opportunity to discuss any residual problems that the patient might have before discharge back to the care of their primary physician. If patients continue to use a topical corticosteroid it is suggested that they see their primary care physician once yearly. Instruction should be given to the patient at the time of their discharge from the clinic warning them that any persistent ulceration or new growth must be reported to their family practitioner who will then make an urgent referral back to an appropriate specialist.
Long-term follow up is, however, required for patients with LS that continues to be poorly controlled. These patients usually have LS with a histological pattern that has features of both LS and LP with squamous cell hyperplasia. Clinically, these patients seem to have an overlap syndrome and their disease runs a relentless course despite trials of various therapies, and a small percentage does go on to develop one or more SCCs.
It is important to biopsy persistent ulcers, erosions, hyperkeratosis and erythematous zones, whether present at initial presentation or subsequently, to exclude intraepithelial neoplasia or invasive SCC.”
Reference
1) http://www.bad.org.uk/healthcare/guidelines/Lichen_Sclerosus.pdf
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