Efficacy of biopsies in diagnosing Lichen Sclerosus

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jlanthi002
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Joined: Mon May 10, 2021 6:24 pm
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by jlanthi002 on Wed May 12, 2021 3:57 pm

Efficacy of biopsies in diagnosing Lichen Sclerosus

:D Good morning,

I am deeply curious about the efficacy of use of biopsies to diagnose and confirm vulvar Lichen Sclerosus.

Many including myself were diagnosed solely by clinical examination and told it was a clear case of Lichen Sclerosus and that no biopsy was needed.

However, it seems that ideally, everyone would be biopsied to confirm, and further, that this would be done BEFORE any steroid treatment so as not to mask any results for the lab technicians.

What is the best practice with respect to diagnosing LS? Should biopsies always be done instead of relying on clinical examination? What about those of us who were never biopsied but have been on long-term steroid use and no official documentation of the LS diagnosis via biopsy?

Also, how effective are biopsies in confirming and diagnosing LS. Can you point me in the direction of medical literature discussing the efficacy and potential problems with biopsies and LS diagnoses? Is it possible that if it's too early a biopsy could give a negative result? How soon should a patient be biopsied?

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Dr Karen Gibbon
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Joined: Wed May 06, 2020 12:28 pm
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by Dr Karen Gibbon on Thu May 13, 2021 6:40 pm

Re: Efficacy of biopsies in diagnosing Lichen Sclerosus

When I first stared doing vulval clinics (last century) we thought it was a good idea to biopsy every patient. I know that was a long time ago and along with other colleagues we've come to realise that a biopsy is not necessary if a sound clinical diagnosis can be made. I now reserve biopsies for patients who fail to respond to treatment or where I am suspicious about potential other diagnoses such as VIN or cancer. A biopsy if taken must be submitted with full clinical information so the pathologist can write a clear report that helps the clinician and patient to move forward. I don't know of any literature that has published particularly on this aspect in connection with LS. It is something we regularly talk about at clinical meetings when different specialists get together to ensure we are looking after patients in the best possible way. Finally - yes, it is possible to miss early LS as inflammation may be very subtle. Also, it depends on exactly where on the vulva the biopsy is taken. Again, it shows how important it is for the clinician to talk to the pathologist and to jointly review biopsy results and talk together.
Dr Karen Gibbon
Consultant Dermatologist

http://www.talkhealthpartnership.com/on ... gibbon.php

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