Vulval carcinoma occurs most frequently in elderly women, peaking in incidence in the sixth and seventh decades, but with 30% of cases arising in premenopausal women. There are approximately 900 new cases per year in the UK. The American Cancer Society estimates the incidence of vulval cancer in the USA will be 3800 new cases in 2002, with 800 deaths expected. Symptoms of vulval malignancy include a mass, pruritus, pain and discharge. Human papilloma virus (HPV) infection is believed to predispose to malignant transformation in the vulval epithelium. Women presenting with invasive squamous carcinoma often have a history of vulval intraepithelial neoplasia (VIN) with histological evidence of viral infection in the vulval epithelial cells. As with the relationship between cervical intraepithelial neoplasia and invasive cervical carcinoma, there is postulated to be a progression from low grade VIN (dysplasia) to high grade VIN (carcinoma In situ) with eventual development of invasive carcinoma. Chronic vulvitis from any cause may also predispose to VIN and invasive squamous carcinoma.