Diagnosis by biopsy?

[Guest Posts]

Hi,
My question is…..
I have been treated for VIN 2 & 3 with several excisions/biopsies/aldara. Initial biopsy showed no lichen sclerosis. In the last few months, symptoms have worsened and the gynaecologist thinks it is now lichen sclerosis. I have been treated for 3 months With clobetasol, with a little improvement. It is possible I initially used too much and had thrush/steroid burn. The consultant did not do a biopsy just a visual diagnosis.

‘Does lichen sclerosis need to be diagnosed via biopsy…and will it always show up on biopsy?’

Thank you so much. Abi

[Dr Rosalind Simpson]

Thank you for your post.

The diagnosis of LS can usually be made from the its typical appearance, by a health care professional who is experienced in the diagnosis and management of the LS. If there is any doubt, a small skin biopsy may be taken and examined under a microscope to confirm the diagnosis, especially if there is an open sore or a thickened area of skin. This is the recommendation in the UK.

It is important that a biopsy is taken from the correct place, as guided by someone experienced in managing vulval conditions. This is because skin biopsy only takes a small sample and must be taken from a representative area where the visible signs are most apparent. If taken from a non-representative area, it may not show typical LS features.

I recommend that you see your doctor for further assessment if your symptoms are not settling. This is even more important on a background history of VIN.