This article provides clear, patient-focused information about vulvar cancer — how it starts, the common types, warning signs, how doctors diagnose it, and the treatment options available. Vulvar cancer is a malignant disease that begins in the tissues of the vulva, the external female genital area that includes the clitoris and the vaginal lips (labia), plus the skin around the urethral opening and the entrance to the vagina. It often appears as a lump, ulcer, or sore that may itch, burn, or bleed.

Vulvar cancer is uncommon compared with other gynecologic cancers; incidence is relatively low (see professional sources such as national cancer registries for exact rates). It can affect people of any age but is diagnosed more often in older adults. Treatments focus on removing the cancer while preserving as much healthy tissue and function as possible — most commonly with surgery, sometimes combined with radiation or chemotherapy depending on the stage and spread to nearby lymph nodes or other body areas.

If you notice persistent vulvar changes — new lumps, non-healing sores, ongoing itching, or unexplained bleeding — see your doctor promptly. Early diagnosis usually means less extensive surgery and better outcomes. This article offers information to help you understand the disease and prepare questions for your health care provider.

What Is Vulvar Cancer?

Vulvar cancer is an uncommon cancer that starts in the tissues of the vulva — the external female genital area that includes the labia (inner and outer vaginal lips), the clitoris, and the skin around the urethral and vaginal openings. Although it is rare compared with other gynecologic cancers, vulvar cancer can occur at any age.

There are two main pathways by which vulvar cancer develops: an HPV-related pathway (often linked to high‑risk human papillomavirus infections) and a non‑HPV pathway that is commonly associated with chronic skin conditions such as lichen sclerosus. In many cases, cancer is preceded by precancerous changes called vulvar intraepithelial neoplasia (VIN) — abnormal growth of cells in the outer layer of vulvar skin. VIN may appear as persistently itchy, scaly, or discolored patches that can evolve over months or years.

Understanding whether a lesion is HPV-related or associated with other skin changes helps doctors choose the most appropriate diagnostic tests and treatments. This article will explain the common types, signs, and next steps if abnormal vulvar cells are found.

What Causes Vulvar Cancer?

Cancer develops when changes (mutations) occur in a cell’s DNA and cause the cells to grow and divide in an uncontrolled way. Over time these abnormal cells can accumulate, form a tumor, invade nearby tissue, and — in some cases — spread to other parts of the body. The exact triggers for these mutations are not always known, but doctors have identified several factors that increase the risk of developing vulvar cancer.

  • Age: The risk of vulvar cancer rises with age. Although it can occur in younger people, most diagnoses happen in older adults (see cancer registry data for current age distributions).
  • HPV (human papillomavirus): High‑risk strains of HPV are linked to a pathway of vulvar cancer. Persistent HPV infection can cause abnormal growth of vulvar cells and is also a known cause of other cancers, such as cervical cancer.
  • Smoking: Tobacco use is associated with a higher risk of vulvar cancer; stopping smoking is a recommended risk‑reducing step for overall health.
  • Weakened immune system: People taking immunosuppressive drugs (for example after organ transplant) or those with immune‑weakening conditions such as HIV have an increased risk, since the immune system helps control virus‑related and abnormal cell growth.
  • History of precancerous changes (VIN): Vulvar intraepithelial neoplasia (VIN) describes abnormal cells in the outer layer of vulvar skin. Most VIN cases do not become invasive cancer, but a minority can progress over months or years to invasive vulvar cancer, so doctors often monitor or treat VIN.
  • Chronic vulvar skin conditions: Conditions such as lichen sclerosus — which cause thinning, scarring, and itching of vulvar skin — are linked to a non‑HPV pathway to vulvar cancer and require regular follow‑up.

Clinically, vulvar cancer generally follows two main pathways: an HPV‑related route (more common in younger patients and associated with warty or basaloid lesions) and a non‑HPV route (more common with chronic skin disease such as lichen sclerosus). This distinction matters because it affects how doctors evaluate lesions, the role of HPV testing, and sometimes treatment choices.

Practical risk‑reduction tips: consider HPV vaccination if eligible (it prevents HPV infection linked to several cancers), stop smoking, and report any persistent vulvar skin changes to your health care provider. If you have VIN or lichen sclerosus, follow recommended surveillance to detect any early signs of progression.

What Are the Symptoms of Vulvar Cancer?

Symptoms of vulvar cancer vary, but some signs are more common and should prompt medical evaluation. Early changes are often subtle (for example, persistent itch or skin changes), while invasive disease may produce lumps, ulcers, or bleeding. Below are frequently reported symptoms and practical guidance on when to see a doctor.

  • Persistent itching or burning of the vulva — chronic itch is one of the most common early complaints and may be a sign of VIN or other skin changes.
  • Changes in vulvar skin color or texture — new red, white, or darker patches, scaly or thickened areas, or a wart‑like appearance.
  • A lump, mass, or non‑healing sore (ulcer) — these findings are more suggestive of invasive vulvar cancer and should be checked promptly.
  • Unexplained bleeding or discharge from the vulvar area — bleeding unrelated to menstrual cycles is a red flag.
  • Pain or tenderness in the vulva or groin — pain during urination or sexual activity, or new groin discomfort, may accompany more advanced lesions.
  • Increased sensitivity or soreness of the vulva — ongoing sensitivity that does not improve with usual self‑care.

Practical guidance: see your doctor if you have any new or persistent vulvar changes lasting more than 4 weeks, especially a lump, non‑healing sore, unexplained bleeding, or worsening pain. For conditions like VIN, symptoms tend to be scaly, itchy patches, while invasive cancer is more likely to present as a lump or ulcer. Early evaluation helps with timely diagnosis and can reduce the need for more extensive treatment.

Types of Vulvar Cancer

Knowing the type of vulvar cancer — that is, the kind of cells where the cancer started — helps doctors plan the most effective treatment. Most vulvar cancers are grouped by the cell of origin and by the usual causes (for example, HPV‑related versus non‑HPV pathways). The common and less common types include:

  • Squamous cell carcinoma: The most common type, arising from the surface epithelial cells of the vulva. Squamous cell carcinomas can be HPV‑related (often seen in younger people) or non‑HPV keratinizing tumors (more often linked to lichen sclerosus).
  • Vulvar melanoma: Begins in melanocytes, the pigment‑producing cells of the vulvar skin. Melanoma behaves differently from carcinoma and is treated according to melanoma guidelines.
  • Adenocarcinoma (including Bartholin gland carcinoma): Arises from glandular cells and can include cancers that start in Bartholin glands near the vaginal opening.
  • Verrucous carcinoma: A rare, slow‑growing subtype of squamous carcinoma that looks wart‑like and is less likely to spread but may require wide local excision.
  • Paget disease of the vulva: A distinct skin‑based cancer that often causes red, itchy patches and can be associated with underlying adenocarcinoma.

Each type behaves differently and may require different treatment approaches (for example, surgical margins, lymph node assessment, or specialist systemic therapy). Your doctor will use pathology from a biopsy to identify the exact carcinoma type and plan treatment based on tumor type, size, location on the labia or other vulvar parts, and stage.

Diagnosis Methods for Vulvar Cancer

If a doctor suspects vulvar cancer, the diagnostic process begins with a focused medical history and a careful physical exam. Your doctor will ask about symptoms, personal and family medical history, medications, and any prior vulvar conditions (such as VIN or lichen sclerosus). A targeted vulvar and pelvic examination follows to inspect the vulva, labia, clitoral area, and the opening of the vagina and urethra for any abnormal spots, lumps, or sores.

  • Vulvar and pelvic exam: The clinician inspects the vulva visually and by touch. If an area looks suspicious, a biopsy (punch or excisional) is taken so a pathologist can examine the cells under a microscope and confirm whether cancer is present and which cell type it is.
  • Colposcopy and directed biopsies: A colposcope (magnifying light) can help highlight abnormal patches. Simple stains (acetic acid or iodine) may be used during colposcopic assessment to guide precise biopsy sampling of abnormal tissue.
  • HPV testing and laboratory studies: If appropriate, samples may be tested for high‑risk HPV strains, which helps classify whether the lesion is HPV‑related. Blood tests are not diagnostic for vulvar cancer but can be part of general preoperative assessment.

Once a biopsy confirms cancer, staging determines whether the cancer has spread (for example, to nearby lymph nodes in the groin) and helps guide treatment. Staging usually involves physical exam and imaging studies; typical imaging options include:

  • MRI: Useful for detailed views of local tumor size and relationship to nearby structures (vagina, urethra, or anus).
  • CT scan or PET‑CT: Often used to evaluate spread to lymph nodes (including nodes in the groin) or distant sites. PET‑CT can be helpful for assessing metabolic activity of suspicious lymph nodes.
  • Ultrasound: May be used to evaluate groin lymph nodes or guide biopsies of accessible nodes.

Lymph node assessment is a key part of staging. For many early vulvar cancers, sentinel lymph node biopsy (a procedure identifying the first draining lymph node) is preferred to a full groin lymph node dissection because it reduces complications while accurately detecting microscopic spread. If sentinel or imaging studies suggest nodal involvement, your doctor may recommend a full lymph node dissection of the groin nodes or targeted treatment.

Biopsy results provide the definitive diagnosis (type of cancer and pathological features). After a positive biopsy, the usual next steps are referral to a gynecologic oncologist, completion of staging imaging, and a multidisciplinary review to plan treatment (surgery, radiation, chemotherapy, or combinations). If you wonder, “If my biopsy is positive, what happens next?” — expect staging tests, discussion of lymph node assessment (sentinel lymph vs. dissection), and a personalized treatment recommendation based on the tumor’s stage and type.

Practical information: ask your doctor which biopsy was performed (punch vs. excisional), whether HPV testing was done, what imaging is planned to check for lymph node spread, and whether a gynecologic oncologist will coordinate your care. Early and accurate diagnosis of stage and lymph node status helps choose the most appropriate treatment and can affect outcomes and the extent of surgery required.

Treatment of Vulvar Cancer

Treatment for vulvar cancer depends on the cancer type, stage, tumor location and size, lymph node status, and the patient’s overall health and preferences. Care is usually coordinated by a gynecologic oncologist as part of a multidisciplinary team. The main goals are to remove the cancer, evaluate and manage lymph nodes (especially groin nodes), preserve function when possible, and reduce the risk of cancer spread to other parts of the body.

Surgery — primary treatment

Surgery is the most common treatment for vulvar cancer. Surgical approaches are chosen to remove the tumor with safe margins while minimizing impact on sexual and urinary function when possible. Common surgical procedures include:

  • Wide local excision / local excision: Removes the tumor plus a rim of healthy tissue (adequate margins). Often used for smaller, early tumors.
  • Vulvectomy: Partial or radical removal of part or all of the vulva; may require skin grafts or reconstructive procedures. Radical vulvectomy is reserved for more extensive tumors.
  • Laser surgery: May be used for very superficial lesions or certain precancerous changes, but is less common for invasive cancer.
  • Pelvic exenteration: A rare, extensive procedure used only for very advanced disease that involves nearby organs. It removes multiple pelvic organs and has significant functional consequences; it is considered only when other treatments are insufficient.

Lymph node management

Assessment of lymph nodes (especially groin/inguinal nodes) is a critical part of treatment planning because lymph node spread is a major factor in stage and prognosis. Options include:

  • Sentinel lymph node biopsy: For many early-stage vulvar cancers, surgeons use a sentinel lymph node procedure to identify and test the first draining lymph node. If the sentinel node is negative, a full groin dissection may be avoided, reducing complications such as lymphedema.
  • Groin (inguinal) lymph node dissection: Recommended when sentinel node is positive or when nodes are clinically suspicious on exam or imaging. Removal of multiple lymph nodes helps control regional spread but carries higher risk of side effects.

Radiation therapy

Radiation therapy uses high‑energy X-rays to kill cancer cells and may be used:

  • As adjuvant treatment after surgery when margins are close or lymph nodes are involved.
  • As definitive treatment for patients who cannot have surgery or when tumors are large or locally advanced.
  • Often combined with chemotherapy (chemoradiation) in selected cases to improve effectiveness against spread to lymph nodes or nearby tissues.

Chemotherapy and systemic treatments

Chemotherapy uses drugs that travel through the body to target cancer cells. It may be:

  • Given before surgery (neoadjuvant) to shrink large tumors,
  • Given after surgery (adjuvant) to treat microscopic spread,
  • Used with radiation (chemoradiation) for locally advanced disease, or
  • Used as palliative treatment for metastatic disease.

Specific chemotherapy agents and newer systemic options (including targeted therapies or immunotherapy) may be considered depending on cancer type (for example, melanoma is treated differently than squamous carcinoma). Your oncologist will discuss recommended regimens and likely side effects.

Reconstruction, side effects, and survivorship

After surgery, reconstructive procedures can help restore vulvar anatomy and improve function. Common side effects of treatments include wound healing issues, lymphedema (especially after groin node removal), changes in sexual function, urinary or bowel changes, fatigue, and skin changes from radiation. Survivorship care includes regular follow‑up visits and surveillance exams to check for recurrence and manage long‑term effects.

How treatment decisions are made

Treatment choices are individualized. Key factors include tumor type (carcinoma vs. melanoma vs. other), stage, lymph node status, tumor size and location on the labia or other vulvar parts, and patient goals for function and quality of life. Multidisciplinary tumor boards (surgeons, radiation oncologists, medical oncologists, pathologists, and supportive care specialists) often review cases to recommend the best approach.

Practical next steps: if cancer is confirmed, ask to be referred to a gynecologic oncologist, request clear information about sentinel lymph node versus full groin dissection, and discuss reconstruction and rehabilitation options. Early diagnosis and appropriate staging of lymph nodes help limit the extent of surgery and improve outcomes.

If you notice symptoms that could suggest vulvar cancer — a new lump, persistent sore, unexplained bleeding, or ongoing vulvar skin changes — seek medical evaluation promptly. Your doctor can guide diagnosis, staging, and the range of available treatments to best fit your situation and health goals.