Objective: To assess the risk of vulvar cancer and precursors in a cohort of women with vulvar lichen planus (LP) and the clinical and therapeutic features of these patients. Design: retrospective case series review Setting: Lower genital tract Unit of a tertiary hospital in Porto, Portugal Participants: 127 women with the diagnosis of vulvar LP, followed in one institution during a period of eleven years - January 2008 until December 2018. Main outcome measures: Demographic and clinical data were evaluated, as well as treatment, follow-up and histology results. Results: A total of 127 women were diagnosed with vulvar LP. The mean follow-up time was 3.90.5 years (range 1-11 years). Ultra-potent topical corticosteroids were first line treatment in 91.8% (n=112), with 32 cases (25.2%) needing an alternative treatment. An overall of 30 biopsies were performed, in 19 women (15%). Vulvar HSIL was diagnosed in 3 (2.4%) women, 2 (1.6%) of which were later diagnosed with vulvar squamous cell carcinoma. No cases of differentiated vulvar intraepithelial neoplasia were observed. Conclusion: Pre-malignant/malignant transformation in women with vulvar LP under surveillance and compliant with treatment is low. A close follow-up appears to be crucial to prevent future malignancy. Biopsies should be performed whenever a suspicious lesion appears during the follow-up.