General
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• Not an entity, only a description of a morphological alteration of vulvar skin
• Squamous cell hyperplasaia related to chronic irritation
• Does not appear to be precursor to HIV negative squamous cell carcinoma (Hum Pathol 1996;27:389)

Terminology
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• Formerly called hyperplastic dystrophy or leukoplakia
• Suggested to diagnose as dermatosis, not a squamous hyperplasia (Mod Pathol 1997;10:401)

Clinical features
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• 2/3 premenopausal
• Pink-red vulva with overlying gray-white keratin
• Pruritus followed by a cycle of itching, scrubbing and scratching
• A diagnosis of exclusion on the basis of specific anatomical-clinical features

Prognostic factors
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• May be observed next to invasive squamous cell cancer, although risk of invasive cancer for women treated for squamous cell hyperplasia without intraepithelial neoplasia is minimal
• Squamous cell hyperplasia occurring in a background of lichen sclerosus constitute a distinct group at higher risk of developing invasive cancer

Treatment
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• Topical corticosteroids, fluorinated compounds in ointments relieve itching

Micro description
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• Elongation, widening of the rete ridges and irregular thickening of the Malpighian layer of rete ridges (acanthosis); hyperkeratosis, and chronic inflammation in dermis
• May have increased mitotic figures in basal and prickle cell layers, but no atypia
• Parakeratosis may be present

Micro images
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Prostate: hyperkeratosis, papillomatosis, acanthosis

Additional references
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• University of Michigan - Vulva-Squamous Hyperplasia

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