The rarity of vulval cancer has meant that few, if any, robust randomised trials have been performed. Women with predisposing conditions should be counselled with regard to risk. This rarity, combined with the modesty that women might feel owing to the intimate location of the problem means that cancer might be easily overlooked, misdiagnosed or ignored. Diagnosis of vulval cancer is made based on biopsy. The major factors that influence treatment planning are the need to assess nodal status, the extent of the disease and the woman's suitability for treatment. Pelvic node involvement tends to follow inguinofemoral spread of disease. Preoperative radiotherapy should be considered if primary surgery is likely to compromise sphincter function. The requirement for reconstruction should be considered in all patients undergoing surgery for vulval cancer. Sentinel node sampling is a recent innovation, which provides diagnostic information to direct further care while minimising morbidity.