When should I consider referring a patient with lichen sclerosus to a specialist for further management?

Consider referring a patient with lichen sclerosus to a specialist for further management if:

• The diagnosis is uncertain or requires confirmation.
• Symptoms persist despite appropriate primary care management, including use of potent topical corticosteroids.
• There is suspicion of a potentially pre-malignant condition or malignant transformation, such as vulval intraepithelial neoplasia or penile squamous cell carcinoma.
• Complications arise that may require surgical intervention, for example phimosis, meatal stenosis, or urethral stricture in male genital lichen sclerosus.
• There is a need for specialist monitoring due to the risk of malignant transformation associated with lichen sclerosus.

Referral urgency depends on clinical suspicion; urgent or two-week referrals are indicated if malignancy is suspected.