Lsa And

Vulvar LSA has been incriminated as a precursor to some vulvar SCC, but the progression is suggested to occur in only 3% to 4% of patients with LSA (10-12). There are no studies to show LSA attack rates in the normal vulva with subsequent "progression" to SCC. The finding of LSA in patients with SCC does not necessarily confirm a causal relation as this may be pure coincidence, but a somewhat higher risk for SCC probably exists for vulvar dysplasia/hyperplasia (13). Because vulvar LSA is a pathologic condition, its ultimate cause may also predispose to SCC, or the LSA may provide a more fertile milieu for carcinogenesis, possibly abetted by loss of local tissue response or diminished immune surveillance. Because the patient with LSA may be at increased risk for SCC, close follow-up is needed especially in those cases where there has been associated squamous cell hyperplasia. A report from a well-known contributor (14) citing increased metabolic activity in LSA with the implication that this was related to progression to SCC was widely accepted when it appeared. Subsequent review suggested a major error in data analysis indicating that there was, in fact, decreased activity consistent with an atrophic lesion.

In the preceding paragraphs, reference has been made to lichen sclerosus et atrophicus (LSA) as opposed to the more common current use of the simpler term, LS. The use of the older, longer name is continued in some current literature (15) but is clearly fading in popularity. This author had the opportunity to work and study with the gynecologist Henry C. Falk, who, along with his colleague in dermatology, Arthur B. Hyman, was largely responsible for establishing the diagnostic criteria for this entity and clarifying the previous confusion regarding vulvar disease. "Kraurosis," an imprecise and overly inclusive term, has been appropriately jettisoned. The longer name, LSA is used here, partly out of loyalty (16,17). As in other parts of language, usage dictates meaning and the shorter version is in vogue. But, the histologic appearance of the epithelium certainly merits recognition of atrophy (atrophicus), while the dermal appearance may not be appropriately called sclerotic (sclerosus) and future studies of the mechanism for the homogenization of the dermis with the round cell infiltrate may lead to a more specific name.

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