Journal of Obstetrics and Gynaecology
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
A survey on the use of topical steroids in patients treated for lichen sclerosus-associated vulval squamous cell carcinoma Rachel Pounds, Sanna Tahir, Christopher Dawson, Ciaran Woodman, David Luesley & Jason Yap To cite this article: Rachel Pounds, Sanna Tahir, Christopher Dawson, Ciaran Woodman, David Luesley & Jason Yap (2017): A survey on the use of topical steroids in patients treated for lichen sclerosus-associated vulval squamous cell carcinoma, Journal of Obstetrics and Gynaecology, DOI: 10.1080/01443615.2017.1352572 To link to this article: http://dx.doi.org/10.1080/01443615.2017.1352572
Published online: 10 Oct 2017.
Submit your article to this journal
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [La Trobe University]
Date: 16 October 2017, At: 04:30
JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2017 https://doi.org/10.1080/01443615.2017.1352572
ORIGINAL ARTICLE
A survey on the use of topical steroids in patients treated for lichen sclerosusassociated vulval squamous cell carcinoma Rachel Poundsa, Sanna Tahirb, Christopher Dawsonc, Ciaran Woodmanc, David Luesleyc and Jason Yapc a Birmingham Women’s Hospital, Mindelsohn Way, Birmingham, United Kingdom; bSchool of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; cInstitute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
KEYWORDS
Downloaded by [La Trobe University] at 04:30 16 October 2017
ABSTRACT
Evidence suggests that lichen sclerosus (LS) is the primary aetiological factor for local vulval recurrence (LVR) in vulval squamous cell carcinoma (VSCC). The long-term application of topical corticosteroids is believed to prevent LVR. Patients treated for LS-associated VSCC at a gynaecological cancer centre were invited to complete a questionnaire to evaluate whether they are receiving corticosteroids. 55 of the 95 eligible patients (58%) completed the questionnaire; LS was treated in 69%, with steroids given to 84.2%. Most received steroids >3 months, but discontinued treatment once asymptomatic. An online survey was distributed to 313 British Gynaecological Cancer Society members to determine whether gynaecological oncologists prescribe corticosteroids for LS following VSCC surgery. 41 consultants (13.1%) completed the survey; 70.7% prescribe topical corticosteroids (potent/very potent in 79.3%), and 58.6% treat >1 year. Our findings demonstrate that patients are more likely to be given topical corticosteroids if symptomatic of LS. Furthermore, although treatment regimens vary, the majority of respondents advocate the use of very potent steroids and would support a tertiary chemopreventative trial.
Vulval squamous cell carcinoma; lichen sclerosus; topical corticosteroid
IMPACT STATEMENT
What is already known on this subject: Local vulval recurrence (LVR) affects approximately one in four women who have received surgery for vulval squamous cell carcinoma (VSCC). What the results of this study add: Lichen sclerosus (LS), an inflammatory dermatosis, is recognised as the likely primary aetiological factor for LVR. Although there is evidence to suggest that long-term topical corticosteroid use in patients with residual LS may prevent LVR, the extent to which women were given topical steroids following surgery remains unclear. Our patient questionnaire evaluates if these patients are already receiving topical steroids, along with the strength of such steroids and duration of treatment. The consultant survey determines whether clinicians currently prescribe topical steroids following VSCC surgery, as well as the strength and duration of steroid therapy. What the implications are of these findings for clinical practice and/or further research: We aim to establish whether the gynaecological oncology community believe that long-term steroids may prevent LVR in women with LS-associated VSCC and whether they would support and recruit to a multicentre tertiary chemopreventative trial. These findings could influence a future clinical trial and may alter the ongoing management of these women.
Introduction Vulval squamous cell carcinoma (VSCC) accounts for 3–6% of all female genital tract carcinomas. Approximately 1300 new cases are reported in the UK annually, of which the estimated mortality rate is 400 cases per annum (Cancer Research UK 2016). The management of this disease is often challenging as most patients are elderly and often present with multiple medical comorbidities. Currently, radical surgery remains the mainstay of treatment for VSCC, but local vulval recurrence (LVR) is common, affecting at least one in four patients within
5 years following primary surgery (Fonseca-Moutinho et al. 2000; Coulter and Gleeson 2003; Yap et al. 2017). Although inadequate surgical margins are thought to be the major contributing factor to the development of LVR (Heaps et al. 1990), this belief is increasingly being challenged by new evidence (Groenen et al. 2010; Woelber et al. 2011; Yap et al. 2016). We have recently published a retrospective cohort study evaluating the clinicopathological factors that predict LVR in one of the largest cohorts of consecutive cases of primary VSCC treated at a tertiary gynaecological cancer centre (Yap et al. 2016). Consistent with previously published
CONTACT Jason Yap [email protected] Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom Supplemental data for this article can be accessed here. ß 2017 Informa UK Limited, trading as Taylor & Francis Group
Downloaded by [La Trobe University] at 04:30 16 October 2017
2
R. POUNDS ET AL.
findings (Tantipalakorn et al. 2009; Regauer 2011), we have found that lichen sclerosus (LS) was the single most important prognostic factor that predicts LVR. Furthermore, our analysis showed, for the first time, that more than half of LVR cases occurred at a distance of 2 cm or greater from the primary tumour. It is believed that these distant LVRs most likely constitute new primary tumours that are either genetically related or unrelated to the primary tumour and are distinct from true local relapses (Braakhuis et al. 2005). This pattern of local recurrence has previously been observed in HPV-negative head and neck squamous cell carcinoma (HNSCC) and is consistent with the concept of distant local recurrences arising within a field of molecularly altered pre-neoplastic epithelium (Dakubo et al. 2007). Based on the current histopathological evidence, we believe that LVR in VSCC is fuelled by the underlying inflammatory dermatosis associated with LS. LS is a non-neoplastic, chronic inflammatory dermatosis with a characteristic histology and predilection for the anogenital skin. The resulting epithelial injury caused by LS, and also seen in differentiated vulvar intraepithelial neoplasia (dVIN), is associated with keratinising tumours (Kurman et al. 1993; Ueda et al. 2011). Although it is still debateable whether LS is a precursor lesion of dVIN or whether dVIN gives rise to HPV-negative VSCC (Yap et al. 2017), many cohort studies, including ours, have found that LVRs were more likely to occur in the residual LS left behind after surgery (Tantipalakorn et al. 2009; Regauer 2011; Yap et al. 2016). It is believed that chronic inflammation induces cumulative molecular changes to the underlying epithelium, which, over time, leads to the development of an LVR. Although LS affects the anogenital skin in continuity, current surgical practice for VSCC arising in the background of LS only focuses on removing the primary tumour, thereby avoiding significant physical and psychosexual comorbidities. Any residual LS may then predispose patients to the development of an LVR. Topical steroids have been used clinically to relieve the symptoms associated with LS and to prevent or reverse disease progression, as the disease often causes atrophy and destruction of the vulval architecture if left untreated (Bradford and Fischer 2010). In addition, a clinical study evaluating the use of topical steroids for the treatment of LS found that while a small proportion of women developed VSCC, none in the compliant group developed cancer (Lee et al. 2015). This finding suggests that the long-term application of topical steroids in LS may prevent the development of VSCC and LVR. As it remains unclear if topical steroids are routinely prescribed to patients in the United Kingdom following curative surgery for VSCC arising in a background of LS, we have conducted two separate survey questionnaires on patients and clinicians registered with the British Gynaecological Cancer Society, respectively.
Materials and methods Patients’ questionnaire All patients treated at the Pan Birmingham Gynaecological Cancer Centre diagnosed with primary VSCC between January 1 2010 and October 14 2014 were identified from
the centre’s multidisciplinary team database. Histology reports were reviewed to identify patients with a diagnosis of LS-associated VSCC. A survey questionnaire (see Supplementary Figure 1(a)) which aims to establish the symptoms of LS and current use of topical steroids was created by the Birmingham Vulval Neoplasia Study Group and sent to patients by post.
Consultants’ survey To evaluate the current practice on how LS is managed following primary excision of VSCC, an online survey was generated by the Birmingham Vulval Neoplasia Study Group using SurveyMonkey and distributed to all members of the British Gynaecological Cancer Society in the United Kingdom with the help of the society’s administrative staff. The survey remained accessible for 6 weeks. An example of the survey questionnaire is shown in Supplementary Figure 1(b). We also explored whether clinicians within the gynaecological oncology community would support a chemopreventative trial of long-term topical steroid therapy in patients who have previously had surgery for LS-associated VSCC to prevent LVR.
Statistical analysis Categorical variables were analysed using the chi-squared test and a p-value of less than .05 was regarded as statistically significant.
Results Outcome of patients’ questionnaire A total of 313 primary VSCC cases were identified. 218 cases (69.6%) were excluded from the study for reasons that are listed in Figure 1. 95 patients with histological confirmation of LS-associated VSCC were invited to partake in the survey and of these, 55 completed the questionnaire, giving a response rate of 58%. 35 women (64%) reported to be symptomatic from their LS (itching, soreness or irritation of the vulva) for at least six-month duration. 69% (n ¼ 38) received topical treatment for their LS, but only 49% (n ¼ 27) patients were aware of their diagnosis. Those patients who were aware of their diagnosis were more likely to have received topical treatment; all 27 patients who were aware received treatment, compared to 11 (39.3%) of those not aware (p < .01). Women were just as likely to have received topical steroid treatment before VSCC surgery as they were afterwards, 51% versus 53% (n ¼ 28 and n ¼ 29, respectively). This trend was consistent in both symptomatic and asymptomatic women (Table 1). Topical corticosteroids were prescribed to 84.2% (n ¼ 32) of the patients who received treatment for their LS. 76.3% (n ¼ 29) were given ointments containing either very potent or potent strength steroid. The remaining patients who were treated received emollients or an antifungal cream (Table 2). The duration of topical steroid therapy was variable and ranged from 4 weeks to 25 years with most patients receiving treatment for over 3 months (65.8%, n ¼ 25). The majority
JOURNAL OF OBSTETRICS AND GYNAECOLOGY
3
Downloaded by [La Trobe University] at 04:30 16 October 2017
Figure 1. The cohort of vulval squamous cell carcinoma (VSCC) cases, including those with lichen sclerosus (LS) and those excluded from the study.
Table 1. Patients’ survey: the correlation of lichen sclerosus (LS) treatment and awareness between symptomatic and asymptomatic women.
Aware of LS diagnosis Treated for LS Treated prior to surgery Treated after surgery
Symptomatic women (n ¼ 35) 25 (71.4%) 33 (94.3%) 25 (71.4%) 26 (74.3%)
Asymptomatic women (n ¼ 20) 2 (10.0%) 5 (25.0%) 3 (15.0%) 3 (15.0%)
Table 2. Patients’ survey: the type and frequency of treatment for patients with lichen sclerosus (LS)-associated vulval squamous cell carcinoma (VSCC). Treatment duration 3 months–1 year >1 year Unsure Average treatment durations Median duration Mean duration Mean duration before surgery Mean duration after surgery Type of treatment Topical steroid (all strengths) Very potent steroid Potent steroid Moderately potent steroid Mildly potent steroid Nonsteroid Unsure Timing of steroid treatment in relation to VSCC surgery Steroids given before surgery Steroids given after surgery Prescribing clinician Gynaecologist alone General practitioner alone Gynaecologist and general practitioner combined Unsure
N (%) 7 (18.4) 3 (7.9) 8 (21.1) 17 (44.7) 3 (7.9) Months 12 47 54 58 N (%) 32 (84.2) 24 (63.1) 5 (13.2) 2 (5.3) 1 (2.6) 3 (7.9) 3 (7.9) N (%) 23 (60.5) 20 (52.6) N (%) 19 (50.0) 9 (23.7) 8 (21.1) 2 (5.3)
(n ¼ 27, 71.1%) reported that their condition was managed by a gynaecologist and only a small minority of patients (n ¼ 9, 23.7%) were managed by their general practitioner alone. Twenty-eight patients (87.5%) reported complete symptom resolution after topical steroid therapy was initiated, with 19 (67.9%) patients using potent or very potent topical steroids.
Table 3. Consultants’ survey: the type and frequency of topical corticosteroid treatment for lichen sclerosus (LS) following vulval squamous cell carcinoma (VSCC) surgery. N (%) Frequency of steroid treatment (n ¼ 41) Always Frequently Rarely Never Unanswered Strength of steroid prescribed (n ¼ 29) Very potent Potent Moderately potent Mildly potent Duration of steroid treatment (n ¼ 29)
ISSN: 0144-3615 (Print) 1364-6893 (Online) Journal homepage: http://www.tandfonline.com/loi/ijog20
A survey on the use of topical steroids in patients treated for lichen sclerosus-associated vulval squamous cell carcinoma Rachel Pounds, Sanna Tahir, Christopher Dawson, Ciaran Woodman, David Luesley & Jason Yap To cite this article: Rachel Pounds, Sanna Tahir, Christopher Dawson, Ciaran Woodman, David Luesley & Jason Yap (2017): A survey on the use of topical steroids in patients treated for lichen sclerosus-associated vulval squamous cell carcinoma, Journal of Obstetrics and Gynaecology, DOI: 10.1080/01443615.2017.1352572 To link to this article: http://dx.doi.org/10.1080/01443615.2017.1352572
Published online: 10 Oct 2017.
Submit your article to this journal
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ijog20 Download by: [La Trobe University]
Date: 16 October 2017, At: 04:30
JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2017 https://doi.org/10.1080/01443615.2017.1352572
ORIGINAL ARTICLE
A survey on the use of topical steroids in patients treated for lichen sclerosusassociated vulval squamous cell carcinoma Rachel Poundsa, Sanna Tahirb, Christopher Dawsonc, Ciaran Woodmanc, David Luesleyc and Jason Yapc a Birmingham Women’s Hospital, Mindelsohn Way, Birmingham, United Kingdom; bSchool of Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; cInstitute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
KEYWORDS
Downloaded by [La Trobe University] at 04:30 16 October 2017
ABSTRACT
Evidence suggests that lichen sclerosus (LS) is the primary aetiological factor for local vulval recurrence (LVR) in vulval squamous cell carcinoma (VSCC). The long-term application of topical corticosteroids is believed to prevent LVR. Patients treated for LS-associated VSCC at a gynaecological cancer centre were invited to complete a questionnaire to evaluate whether they are receiving corticosteroids. 55 of the 95 eligible patients (58%) completed the questionnaire; LS was treated in 69%, with steroids given to 84.2%. Most received steroids >3 months, but discontinued treatment once asymptomatic. An online survey was distributed to 313 British Gynaecological Cancer Society members to determine whether gynaecological oncologists prescribe corticosteroids for LS following VSCC surgery. 41 consultants (13.1%) completed the survey; 70.7% prescribe topical corticosteroids (potent/very potent in 79.3%), and 58.6% treat >1 year. Our findings demonstrate that patients are more likely to be given topical corticosteroids if symptomatic of LS. Furthermore, although treatment regimens vary, the majority of respondents advocate the use of very potent steroids and would support a tertiary chemopreventative trial.
Vulval squamous cell carcinoma; lichen sclerosus; topical corticosteroid
IMPACT STATEMENT
What is already known on this subject: Local vulval recurrence (LVR) affects approximately one in four women who have received surgery for vulval squamous cell carcinoma (VSCC). What the results of this study add: Lichen sclerosus (LS), an inflammatory dermatosis, is recognised as the likely primary aetiological factor for LVR. Although there is evidence to suggest that long-term topical corticosteroid use in patients with residual LS may prevent LVR, the extent to which women were given topical steroids following surgery remains unclear. Our patient questionnaire evaluates if these patients are already receiving topical steroids, along with the strength of such steroids and duration of treatment. The consultant survey determines whether clinicians currently prescribe topical steroids following VSCC surgery, as well as the strength and duration of steroid therapy. What the implications are of these findings for clinical practice and/or further research: We aim to establish whether the gynaecological oncology community believe that long-term steroids may prevent LVR in women with LS-associated VSCC and whether they would support and recruit to a multicentre tertiary chemopreventative trial. These findings could influence a future clinical trial and may alter the ongoing management of these women.
Introduction Vulval squamous cell carcinoma (VSCC) accounts for 3–6% of all female genital tract carcinomas. Approximately 1300 new cases are reported in the UK annually, of which the estimated mortality rate is 400 cases per annum (Cancer Research UK 2016). The management of this disease is often challenging as most patients are elderly and often present with multiple medical comorbidities. Currently, radical surgery remains the mainstay of treatment for VSCC, but local vulval recurrence (LVR) is common, affecting at least one in four patients within
5 years following primary surgery (Fonseca-Moutinho et al. 2000; Coulter and Gleeson 2003; Yap et al. 2017). Although inadequate surgical margins are thought to be the major contributing factor to the development of LVR (Heaps et al. 1990), this belief is increasingly being challenged by new evidence (Groenen et al. 2010; Woelber et al. 2011; Yap et al. 2016). We have recently published a retrospective cohort study evaluating the clinicopathological factors that predict LVR in one of the largest cohorts of consecutive cases of primary VSCC treated at a tertiary gynaecological cancer centre (Yap et al. 2016). Consistent with previously published
CONTACT Jason Yap [email protected] Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom Supplemental data for this article can be accessed here. ß 2017 Informa UK Limited, trading as Taylor & Francis Group
Downloaded by [La Trobe University] at 04:30 16 October 2017
2
R. POUNDS ET AL.
findings (Tantipalakorn et al. 2009; Regauer 2011), we have found that lichen sclerosus (LS) was the single most important prognostic factor that predicts LVR. Furthermore, our analysis showed, for the first time, that more than half of LVR cases occurred at a distance of 2 cm or greater from the primary tumour. It is believed that these distant LVRs most likely constitute new primary tumours that are either genetically related or unrelated to the primary tumour and are distinct from true local relapses (Braakhuis et al. 2005). This pattern of local recurrence has previously been observed in HPV-negative head and neck squamous cell carcinoma (HNSCC) and is consistent with the concept of distant local recurrences arising within a field of molecularly altered pre-neoplastic epithelium (Dakubo et al. 2007). Based on the current histopathological evidence, we believe that LVR in VSCC is fuelled by the underlying inflammatory dermatosis associated with LS. LS is a non-neoplastic, chronic inflammatory dermatosis with a characteristic histology and predilection for the anogenital skin. The resulting epithelial injury caused by LS, and also seen in differentiated vulvar intraepithelial neoplasia (dVIN), is associated with keratinising tumours (Kurman et al. 1993; Ueda et al. 2011). Although it is still debateable whether LS is a precursor lesion of dVIN or whether dVIN gives rise to HPV-negative VSCC (Yap et al. 2017), many cohort studies, including ours, have found that LVRs were more likely to occur in the residual LS left behind after surgery (Tantipalakorn et al. 2009; Regauer 2011; Yap et al. 2016). It is believed that chronic inflammation induces cumulative molecular changes to the underlying epithelium, which, over time, leads to the development of an LVR. Although LS affects the anogenital skin in continuity, current surgical practice for VSCC arising in the background of LS only focuses on removing the primary tumour, thereby avoiding significant physical and psychosexual comorbidities. Any residual LS may then predispose patients to the development of an LVR. Topical steroids have been used clinically to relieve the symptoms associated with LS and to prevent or reverse disease progression, as the disease often causes atrophy and destruction of the vulval architecture if left untreated (Bradford and Fischer 2010). In addition, a clinical study evaluating the use of topical steroids for the treatment of LS found that while a small proportion of women developed VSCC, none in the compliant group developed cancer (Lee et al. 2015). This finding suggests that the long-term application of topical steroids in LS may prevent the development of VSCC and LVR. As it remains unclear if topical steroids are routinely prescribed to patients in the United Kingdom following curative surgery for VSCC arising in a background of LS, we have conducted two separate survey questionnaires on patients and clinicians registered with the British Gynaecological Cancer Society, respectively.
Materials and methods Patients’ questionnaire All patients treated at the Pan Birmingham Gynaecological Cancer Centre diagnosed with primary VSCC between January 1 2010 and October 14 2014 were identified from
the centre’s multidisciplinary team database. Histology reports were reviewed to identify patients with a diagnosis of LS-associated VSCC. A survey questionnaire (see Supplementary Figure 1(a)) which aims to establish the symptoms of LS and current use of topical steroids was created by the Birmingham Vulval Neoplasia Study Group and sent to patients by post.
Consultants’ survey To evaluate the current practice on how LS is managed following primary excision of VSCC, an online survey was generated by the Birmingham Vulval Neoplasia Study Group using SurveyMonkey and distributed to all members of the British Gynaecological Cancer Society in the United Kingdom with the help of the society’s administrative staff. The survey remained accessible for 6 weeks. An example of the survey questionnaire is shown in Supplementary Figure 1(b). We also explored whether clinicians within the gynaecological oncology community would support a chemopreventative trial of long-term topical steroid therapy in patients who have previously had surgery for LS-associated VSCC to prevent LVR.
Statistical analysis Categorical variables were analysed using the chi-squared test and a p-value of less than .05 was regarded as statistically significant.
Results Outcome of patients’ questionnaire A total of 313 primary VSCC cases were identified. 218 cases (69.6%) were excluded from the study for reasons that are listed in Figure 1. 95 patients with histological confirmation of LS-associated VSCC were invited to partake in the survey and of these, 55 completed the questionnaire, giving a response rate of 58%. 35 women (64%) reported to be symptomatic from their LS (itching, soreness or irritation of the vulva) for at least six-month duration. 69% (n ¼ 38) received topical treatment for their LS, but only 49% (n ¼ 27) patients were aware of their diagnosis. Those patients who were aware of their diagnosis were more likely to have received topical treatment; all 27 patients who were aware received treatment, compared to 11 (39.3%) of those not aware (p < .01). Women were just as likely to have received topical steroid treatment before VSCC surgery as they were afterwards, 51% versus 53% (n ¼ 28 and n ¼ 29, respectively). This trend was consistent in both symptomatic and asymptomatic women (Table 1). Topical corticosteroids were prescribed to 84.2% (n ¼ 32) of the patients who received treatment for their LS. 76.3% (n ¼ 29) were given ointments containing either very potent or potent strength steroid. The remaining patients who were treated received emollients or an antifungal cream (Table 2). The duration of topical steroid therapy was variable and ranged from 4 weeks to 25 years with most patients receiving treatment for over 3 months (65.8%, n ¼ 25). The majority
JOURNAL OF OBSTETRICS AND GYNAECOLOGY
3
Downloaded by [La Trobe University] at 04:30 16 October 2017
Figure 1. The cohort of vulval squamous cell carcinoma (VSCC) cases, including those with lichen sclerosus (LS) and those excluded from the study.
Table 1. Patients’ survey: the correlation of lichen sclerosus (LS) treatment and awareness between symptomatic and asymptomatic women.
Aware of LS diagnosis Treated for LS Treated prior to surgery Treated after surgery
Symptomatic women (n ¼ 35) 25 (71.4%) 33 (94.3%) 25 (71.4%) 26 (74.3%)
Asymptomatic women (n ¼ 20) 2 (10.0%) 5 (25.0%) 3 (15.0%) 3 (15.0%)
Table 2. Patients’ survey: the type and frequency of treatment for patients with lichen sclerosus (LS)-associated vulval squamous cell carcinoma (VSCC). Treatment duration 3 months–1 year >1 year Unsure Average treatment durations Median duration Mean duration Mean duration before surgery Mean duration after surgery Type of treatment Topical steroid (all strengths) Very potent steroid Potent steroid Moderately potent steroid Mildly potent steroid Nonsteroid Unsure Timing of steroid treatment in relation to VSCC surgery Steroids given before surgery Steroids given after surgery Prescribing clinician Gynaecologist alone General practitioner alone Gynaecologist and general practitioner combined Unsure
N (%) 7 (18.4) 3 (7.9) 8 (21.1) 17 (44.7) 3 (7.9) Months 12 47 54 58 N (%) 32 (84.2) 24 (63.1) 5 (13.2) 2 (5.3) 1 (2.6) 3 (7.9) 3 (7.9) N (%) 23 (60.5) 20 (52.6) N (%) 19 (50.0) 9 (23.7) 8 (21.1) 2 (5.3)
(n ¼ 27, 71.1%) reported that their condition was managed by a gynaecologist and only a small minority of patients (n ¼ 9, 23.7%) were managed by their general practitioner alone. Twenty-eight patients (87.5%) reported complete symptom resolution after topical steroid therapy was initiated, with 19 (67.9%) patients using potent or very potent topical steroids.
Table 3. Consultants’ survey: the type and frequency of topical corticosteroid treatment for lichen sclerosus (LS) following vulval squamous cell carcinoma (VSCC) surgery. N (%) Frequency of steroid treatment (n ¼ 41) Always Frequently Rarely Never Unanswered Strength of steroid prescribed (n ¼ 29) Very potent Potent Moderately potent Mildly potent Duration of steroid treatment (n ¼ 29)
