The vulva is the external female genital system leading to the vagina. It is located under the triangle of hair which covers the midline pubic bone. Vulva cancer usually starts as a small, hard knot on the skin which turns into a raised ulcer. The ulcer may ooze or bleed and can spread to other parts of the body if left untreated. In other cases, the first symptom may be chronic vaginal itching, though it's important to remember that itching can be a symptom of many, less serious disorders. One possible cause of vulva cancer is certain human papilloma (pap-ih-LOE-muh) viruses, or HPV, which initiate abnormal cell growth. Treatment of vulva cancer may begin with a biopsy or removing a small portion of the lump for further examination. If the growth is malignant, the doctor may choose to do a vulvectomy (vul-VEK-toe-mee), which entails removal of the growth and the surrounding skin or removal of the glands in the groin and the skin in between. Cancer of the vulva is relatively rare, and usually apears after age 60. However, any suspicious symptoms should be checked by your doctor. If detected early, there is a high rate of recovery. For more information about vulva cancer, please contact your health care provider.