Snap Shot A 42-year-old women, gravida 4, para 4, complains of vulvar itching and a raised lesion. Introduction Several types squamous cell carcinoma 90% of vulvular cancers risk factors HPV 16 positivity smoking immunosuppression vulvar intraepithelial neoplasia (VIN) VIN I & II = mild to moderate dysplasia. ↑ risk of carcinoma VIN III = carcinoma in situ strong HPV 16 association may lead to squamous cell carcinoma extramammary Paget's disease PAS positive due to mucin production malignant melanoma simlar histologically to Paget's but PAS negative Presentation Symptoms pruritis irritation and itching raised/crusted lesion Evaluation Biopsy Treatment Excision