Q182) A 65 year old woman presents with a white plaque on her vulva. She has no other hypo-pigmented lesions on her body. She reports history of repeated itching in the area for past several years. She has seen by her gynecologist in the past. Repeated evaluation did not reveal any infection or candidiasis. She says the lesion has not changed in appearance but the itching bothers her. She denies any vaginal bleeding. Physical examination reveals a raised white colored plaque on the vulva. There are excoriations adjacent to and overlying the lesion. Most likely diagnosis:
A) Lichen Sclerosus
B) Lichen Simplex Chronicus
C) Lichen planus
D) Vulvar Cancer
E) Vitiligo
Archer USMLE Step 3 Blog 
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It sounds like lichen simplex chronicus b/c its been going on for years
A Lichen Sclerosis predisposition to cancer…
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A answer .
Lichen Sclerosus most commonly affect Vulva and anus .
White patches .
Lichen simplex chronicus has brownish hue .
this patient is pause menopause : i would go for lichen sclerosis .
As Poonam said , it’s has high risk cancer .
Menopause + vulva itching = suspect lichen sclerosis until proven otherwise .
If we assume it’s benign lichen simplex , we might missed diagnosing it without doing punch biopsy .
Just my 2 cents 🙂
ans AAA
D – This is a single plaque, not multiple papules. Based on this I would say this is suspicious for vulvar cancer.
Lichen simplex chronicus causes leathery, brown plaques.
Answer A (sclerosus).