If a GP suspects a patient has vulval cancer, they should be referred via the gynae 2WW vulval clinic.
Patients with genital dermatoses where it is felt likely that secondary care review will be required should be referred via the genital dermatology RAS. Photos do not need to be included.
Patients with genital dermatoses where it is felt likely that the GP will be able to continue to manage the patient with advice should be referred via A&G.
- Uncomplicated vulval lichen sclerosus can be managed in primary care and diagnostic biopsies are only required if there is diagnostic doubt, or failure to respond to treatment
- However, it is preferable that no super potent topical steroid has been used for 4 weeks prior to biopsy
Appropriate vulval/genital skin care advice, including use of soap substitutes, emollients and avoidance of irritants.
- Use of lubricants for sex and or topical oestrogens if indicated, if sexually active.
- Super potent topical steroid (eg Dermovate ointment) applied at night, every night for the first month, alternate nights in the second month and in the third month and thereafter at a frequency which keeps their symptoms under control. (A 30g tube should last 3 - 4 months)
- Diagnostic uncertainty
- Complicated Lichen Sclerosus
- Lichen planus
- Any vulval or genital dermatosis not responding to treatment
- Vulval or genital pain syndrome
- Pigmented vulval or genital lesions
- Vulval or penile intraepithelial neoplasia
- there is a male genital dermatology clinic
- British Association of Dermatologists leaflets available at www.bad.org.uk for
- Vulval skin care, lichen Sclerosus, vulvodynia, vestibulodynia
- Patient support group:
- British Society for the Study of Vulval Disease website www.bssvd.org
British Association Dermatologists’ Guidelines for the Management of Lichen Sclerosus 2010
SM Neill, FM Lewis, FM Tatnall and NH Cox