Medicines

Topical steroids advised to prevent vulvar SCC recurrence


Clinicians treating women with vulvar SCC (vSCC) associated with vulvar lichen sclerosus (vLS) are encouraged to prescribe topical corticosteroids after surgery to reduce the patient’s risk of SCC recurrence.

According to a research letter in JAMA Dermatology from a Sydney dermatogynecology practice, suppressive topical corticosteroids are known to reduce the risk of vSCC and differentiated vulvar intraepithelial neoplasia (vDIN) in vLS.

However their role in preventing recurrence of vSCC is less clear.

Dermatologists including Professor Gayle Fischer, shared observations from a review of 11 patients with vLS and previous vSCC or vDIN who were adherent to topical corticosteroid therapy.

Initial management of vSCC had included excision alone or with node biopsy, node dissection or adjuvant laser therapy. Eight of the patients (73%) remain free of recurrence with mean follow-up of 10.5 years.

“In the study cohort, patients with vLS who adhered to topical corticosteroid therapy had a vSCC or VIN recurrence rate of 27% compared with reported 5-year recurrence rates of 44% to 47%.”

“Only 1 patient with a recurrence of vSCC or dVIN had a subsequent recurrence compared with the 5-year subsequent recurrence rate of 80% for untreated vLS.”

They said topical corticosteroids were an inexpensive and safe treatment that could potentially result in considerable cost savings and reductions in morbidity and mortality.

While the study was limited by small numbers, the patients were part of a larger cohort of 2,400 women with vLS who have been prospectively followed since 2008.

“Topical corticosteroid therapy may represent an important management strategy to reduce the recurrence rate of vSCC and dVIN in patients with vLS,” they concluded.

“These findings suggest the need for a large prospective trial. However, in the meantime, we encourage dermatologists to play an active role in assisting colleagues who specialize in gynecology-oncology to use a topical corticosteroid when treating patients with vLS.”

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