Squamous cell carcinoma accounts for approximately 90% of all vulvar carcinomas. The HPV-related vulvar carcinomas are warty or basaloid and found in younger aged women (mean age 40 years), are associated with preinvasive disease, and have similar risk factors as that for cervical cancer. Keratinizing squamous cell carcinoma occur in older women (mean age 70 years) and are more likely to be HPV negative, and are associated with lichen sclerosis or epithelial hyperplasia. The lymphatic channels of the vulva course anteriorly through the labia majora, turn laterally at the mons pubis and drain primarily to the superficial inguinal lymph nodes, then to the deep inguinal lymph nodes, then drain superiorly into the external iliac nodes and then upward to the pelvic and aortic lymphatics. Lateralized lesions drain to the ipsilateral inguinal lymphatics. Mid-line lesions or lesions within 1 cm of the mid-line can drain to either side.

Malignant melanoma of the vulva is a disease of the elderly with the median age of diagnosis of 66 years. It occurs more commonly in white women. Signs and symptoms are similar to other vulvar malignancies and the most common complaint is a vulvar mass. It most commonly arises from the labia minor, the labia majora or the clitoris. There are three subtypes of vulvar melanoma: superficial spreading melanoma (66%), nodular melanoma (24%), and acral lentiginous melanoma (10%). There are many different systems used to stage vulvar melanoma. The AJCC system and the Breslow microstaging system are superior for determining prognosis.