Lichen Sclerosus Is a Risk Factor for De Novo Recurrence of HPV Negative Vulvar Squamous Cell Carcinoma
S Regauer. Medical University Graz, Graz, Austria
Background: There is some debate if lichen sclerosus (LS) should be considered a risk factor for HPV-negative vulvar squamous cell carcinomas (SCC), since more than 50% of patients with vulvar cancer suffer from LS of many years duration. Treatment is a complete wide resection of the SCC. Despite clear margins, some patients develop de novo recurrent SCC in residual LS-affected skin / mucosa. The pattern and time course of recurrences is presented.
Design: 60 patients with a complete surgical excision of LS-associated SCC were evaluated for recurrences occuring >3 months after intitial surgery.
Results: 37/ 60 patients (62%) had no recurrences in an average follow-up of 61 months. 1/60 patients developed a low-grade VIN 18 months after the primary resection, but no invasive SCC during further 48 months follow-up. A total of 21/60 patients (36%; 1 pT3 SCC, 11 pT2 SCC, 8 pT1b SCC and 1 pT1a SCC) developed recurrent invasive SCC in the residual anogenital LS. 18/21 patients with recurrences (86%; average age 66 years, range 43 - 85 years at initial presentation) developed one de-novo SCC in the residual LS. Four / 21 patients (3 pT2, 1pT1b) had multiple recurrences: a 62-yr-old patient had 2 recurrences after 36 months and 24 months later; a 77-yr-old woman had 3 recurrences after 13, 11 and 45 months; a 60-yr-old woman with a pT1b primary SCC had 4 recurrences during 12 years of follow-up after 15, 14, 14, 8 and 4 months resp; a 66-yr-old woman had 5 recurrences after 17, 8, 4, 3 and 3 months. The first recurrence was observed on average 30 months (range 4 – 84 months) after the primary diagnosis of a LS-associated vulvar SCC. There was, however, a bimodal distribution in the pattern of recurrences: 48% (10/21) of recurrent de-novo SCCs were observed within the first 18 months, mostly in less than 10 months or after a long latency of typically more than 60 months (11/21patients ;52%). The inflammatory infiltrate of 4 evaluated primary SCC contained T-lymphocytes with monoclonally re-arranged γ-chain gene of the T-cell receptor.
Conclusions: Once patients have developed an LS-associated SCC, the entire residual LS is at risk for de-novo development of SCC. Recurrences were either rapid within 12 months or after a long latency of several years. The etiology of LS-associated carcinogenensis may be explained by an underlying immune dysregulation with increased numbers of T-cells with monoclonally rearranged γ-gene chain of the T-cell receptor resulting in reduced T-cell receptor diversity with ineffective immune response of tumor infiltrating lymphocytes.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 137, Tuesday Afternoon