Case Number : Case 2231 - 31 December 2018 Posted By: Limin Yu

I'll take a stab at it: there is background lichen sclerosis. The center has acanthosis, slight elongation of the rete ridges, and mild basal keratinocyte atypia. P53 stain is basal and parabasal, and p16 is only focally positive. This central portion probably has differentiated vulvar intraepithelial neoplasia. Although the findings on the H&E is rather subtle I was also wondering if this can just be lichen sclerosis.

Happy New Year to the faculty and all friends that participate the spot discussions at dermpathpro. This is a wonderful learning site and has become my favorate internet hangout. 

Hyperkeratosis,  hypergranulosis, necrotic keratinocytes higher up in the epidermis, vacuolar interface dermatitis and pigment incontinence are the salient features. I wonder whether this could be a fixed drug eruption especially a recurrent one. 

Agree hypertrophic lichen sclerosus. No far not convinced by dysplasia. I tend to run Ki67, p53 & p16. Ki67 should be limited to basal/suprabasal. I the you can allow some elevated dyskeratosis in lichen sclerosis. In any case watchful waiting. 

Hypertrophic LS is my thought too.