Risk of Vulvar Squamous Cell Carcinoma in Women with Vulvar Lichen Planus: A Systematic Review
Keywords:
vulvar lichen planus, vulvar squamous cell carcinoma, high grade squamous intraepithelial lesion, vulvar intraepithelial neoplasia, human papillomavirus independent carcinogenesis, systematic reviewAbstract
This systematic review evaluated whether vulvar lichen planus is associated with malignant change and clarified clinical and biological modifiers of risk. Searches of major medical databases from 2010 to 2025 identified observational cohorts, clinicopathologic series, case–control studies, and case series with at least five participants. Two reviewers independently screened records extracted data on study characteristics, vulvar lichen planus definition, outcome ascertainment, biomarker status, and follow-up, and appraised methodological quality with standard tools. The primary outcome was invasive vulvar squamous cell carcinoma; secondary outcomes included high grade squamous intraepithelial lesion, vulvar intraepithelial neoplasia, time to transformation, and human papillomavirus or surrogate biomarker status. Fifteen studies met eligibility. Direct reports of invasive cancer among women with vulvar lichen planus were present but uncommon and derived mainly from retrospective cohorts and clinicopathologic series; additional signals arose from high grade squamous intraepithelial lesion and vulvar intraepithelial neoplasia, particularly within erosive disease. Clinicopathologic and biomarker findings supported a human papillomavirus independent pathway in many cases, with a possible human papillomavirus associated subset. Certainty was limited by small samples, heterogeneous definitions, and incomplete reporting. Overall, vulvar lichen planus appears to carry a non-zero malignant risk that justifies standardized diagnosis, structured surveillance, timely biopsy of non-healing change, and prospective site-specific research to refine absolute risk and pathway attribution.
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