Malignancies in the vulva are uncommon and comprise 3-4% of genital tract malignancies. Internationally, the incidence of vulvar cancer varies, the highest rates being seen in Portuguese South America and in Portugal; the lowest rates are seen in Asian countries. Asian women who have migrated to Australia continue to be at significantly lower risk for this malignancy. The true incidence in Malaysia is not known. The University of Malaya Medical Centre is a major referral center for gynecological malignancies. Of the 3,125 gynecological malignancies managed during a 12-year period, vulvar malignancies comprised 2.8%; thus, this malignancy is rare in Malaysia. It is essentially a disease of the elderly with a mean age of 56 years in Malaysian women. Over the past 2 decades a subset of women younger than 50 years with squamous cell carcinoma has emerged. Ninety per cent of the malignancies seen are squamous cell carcinomas; melanomas, adenocarcinoma, basal-cell carcinoma and sarcomas are far less commonly seen.