Vulvar cancer most often appears as a persistent lump, sore, or patch of skin on the vulva that looks or feels different from the surrounding tissue. The changes can be subtle at first, sometimes resembling a wart, rash, or simple discoloration, which is one reason diagnosis is frequently delayed. Knowing the specific visual signs, and how they differ depending on the type of cancer, can help you recognize something worth getting checked.
Common Visual Signs
The most recognizable sign is a visible change to the skin of the vulva. This can show up in several ways:
- A lump or raised growth that may feel firm or fleshy, similar in appearance to a wart
- An open sore or ulcer that does not heal over several weeks
- A color change where the skin turns noticeably whiter, redder, darker, or develops patchy discoloration
- Thickened skin that feels rougher or tougher than the surrounding area
- A crusting or scaly patch that may weep or bleed when irritated
These changes often appear on just one side or one area of the vulva rather than symmetrically on both sides. Many people first notice a lump while wiping or bathing. In some cases, there are no symptoms at all, and the change is found during a routine exam.
Where Lesions Typically Appear
About 90% of vulvar cancers are squamous cell carcinomas, and most of these develop on the labia majora, the outer lips of the vulva. Other common sites include the labia minora (inner lips), the clitoris, and the perineum (the area between the vulva and anus). A growth can appear anywhere on the vulvar skin, but lesions on the labia majora are the most frequent.
How Different Types Look
Squamous Cell Carcinoma
This is by far the most common type. It typically presents as a raised, firm lump or a thickened, discolored patch. The surface may look warty or ulcerated. Color changes are common, with the affected skin appearing white, red, or pink compared to the surrounding tissue. In advanced cases, the growth can become an irregular, fungating mass (a bulky, cauliflower-like growth) or a deep, irregular ulcer with uneven borders.
Vulvar Melanoma
Melanomas on the vulva are often dark brown or black, though they can occasionally lack pigment. They tend to appear around the clitoris or on the labia minora or majora. The same warning signs that apply to skin melanoma elsewhere on the body apply here: asymmetry, jagged or uneven edges, mixed colors within the same spot, and a diameter greater than 6 millimeters. A changing mole in the vulvar area deserves prompt attention. Vulvar melanoma is clinically aggressive, and about one-third of cases already have spread at the time of diagnosis, partly because these lesions are in an area people don’t routinely inspect.
Basal Cell Carcinoma
Rare on the vulva, basal cell carcinoma is typically slow-growing. It may appear as a small, pearly or waxy bump, sometimes with visible blood vessels on the surface. It carries a low risk of spreading but can gradually destroy local tissue if left untreated.
Extramammary Paget Disease
This uncommon type looks quite different from the others. It often resembles eczema or a persistent red, scaly rash on the vulvar skin. Because it mimics common skin conditions, diagnosis is frequently delayed. The affected area may itch, burn, or feel sore, and it tends to follow a slow course with a tendency to recur even after treatment.
What Pre-cancerous Changes Look Like
Vulvar cancer often starts as a pre-cancerous condition called vulvar intraepithelial neoplasia, or VIN. These pre-cancerous changes can appear as raised or flat growths, or as patches of skin that turn white, red, pink, gray, brown, or black. They may show up on one part of the vulva or across multiple areas. The skin in the affected zone often becomes noticeably thicker.
One form of VIN (called differentiated VIN) is associated with a chronic skin condition called lichen sclerosus, which causes white patches, thinning skin, and itching. While lichen sclerosus itself is not cancer, it creates an environment where cancer can develop more easily, and the two can look similar. Lichen sclerosus typically causes the skin to appear pale, thin, and crinkled, while a cancerous or pre-cancerous lesion within it tends to be thicker, raised, or ulcerated. Differentiated VIN can progress to invasive cancer relatively quickly compared to other forms.
How Appearance Changes Over Time
Early vulvar cancer can be remarkably subtle. A small, slightly raised patch or a persistent itch with minimal visible change may be the only sign. As the disease progresses, you may notice the lesion growing larger, developing an uneven or irregular surface, or beginning to crust, weep, or bleed. Pain and burning tend to appear later in the disease course and often signal more advanced involvement.
Squamous cell carcinoma presents with locally advanced disease in about 30% of cases, meaning by the time it’s diagnosed the growth is already large or deeply invasive. This is not inevitable. It reflects the fact that early changes are easy to dismiss as a skin irritation, yeast infection, or ingrown hair.
Red Flags That Need Prompt Evaluation
Certain visual features are strong indicators that a lesion needs to be examined and biopsied quickly. An irregular, bulky mass, a non-healing ulcer with uneven borders, or swollen lymph nodes in the groin alongside a vulvar change all raise serious concern. Any new lump, color change, thickened patch, or persistent sore on the vulva in a postmenopausal person warrants a biopsy. The same applies to anything that looks like a wart in a postmenopausal person, or a wart-like growth in a younger person that does not resolve.
A Bartholin cyst or abscess (a swelling near the vaginal opening) that develops for the first time after menopause is another red flag, as it can occasionally be caused by an underlying cancer of the Bartholin gland rather than a simple blocked duct.
The takeaway is straightforward: any persistent change on the vulva that lasts more than a few weeks, especially one that is growing, changing color, bleeding, or not responding to basic treatment, is worth having a clinician look at and biopsy. A biopsy is a brief procedure and the only way to confirm or rule out cancer. Many of these changes turn out to be benign, but the visual overlap between harmless conditions and early cancer is significant enough that guessing from appearance alone is unreliable.