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Patient guide · Gynaecology

Vulval biopsy, outpatient punch biopsy for suspicious or persistent vulval lesions.

A vulval biopsy takes a small skin sample from a suspicious or persistent vulval lesion under local anaesthetic - first-line for lichen sclerosus, VIN, suspected vulval cancer, chronic vulval pain and non-responding dermatoses.

A private gynaecology clinic where a vulval biopsy is performed

Key facts

  • 01

    Definition

    A small skin sample taken from a suspicious or persistent vulval lesion for histopathology.

  • 02

    10–15 minute outpatient procedure

    Performed in a gynaecology or vulval clinic - no admission, no general anaesthetic.

  • 03

    Local anaesthetic (lidocaine)

    Infiltrated at the biopsy site so the punch itself is painless.

  • 04

    3–4 mm punch biopsy

    A hollow circular blade removes a full-thickness core of skin.

  • 05

    Single suture or steri-strip

    The site is closed with one absorbable suture or a steri-strip.

  • 06

    Complements dermoscopy and vulvoscopy

    The biopsy confirms what vulvoscopy and dermoscopy have flagged as suspicious.

How it’s done

From consultation to a clear diagnostic plan.

Seven structured steps - from your first specialist appointment to a definitive histological diagnosis and treatment plan.

  1. 01

    Gynaecology / vulval consultation

    A specialist history and examination - often in a dedicated vulval clinic.

  2. 02

    Vulvoscopy

    Magnified examination of the vulva, sometimes with acetic acid, to map lesions.

  3. 03

    Local anaesthetic

    Lidocaine is infiltrated at the chosen biopsy site.

  4. 04

    Punch biopsy taken

    A 3–4 mm hollow blade removes a full-thickness core of skin.

  5. 05

    Histopathology review

    A specialist gynaepathologist examines the sample under the microscope.

  6. 06

    Structured report

    A formal report is issued - diagnosis, grade if relevant, and margins where applicable.

  7. 07

    Structured plan

    A clear plan is agreed - topical treatment, surveillance, wider excision, or MDT referral.

What it shows

When a vulval biopsy is the right test.

A vulval biopsy answers a specific question - what is this lesion, and does it need treatment. These are the diagnoses we most commonly see.

  • Lichen sclerosus

    A chronic inflammatory skin condition of the vulva that requires biopsy confirmation and long-term steroid care.

  • Lichen planus

    Erosive vulval lichen planus mimics other conditions and needs histology to confirm.

  • Vulval intraepithelial neoplasia (VIN)

    Pre-cancerous change of the vulval skin - graded on biopsy.

  • Vulval Paget’s disease

    A rare intraepithelial adenocarcinoma of the vulva confirmed by biopsy.

  • Vulval melanoma

    Any pigmented vulval lesion warrants urgent biopsy.

  • Bartholin gland cyst / lesion

    Persistent or atypical Bartholin lesions in older women are biopsied to exclude malignancy.

  • Chronic vulvitis

    Persistent inflammation not responding to standard care - biopsy clarifies the underlying cause.

  • Red flag: vulval cancer or melanoma - urgent MDT

    Suspected vulval cancer or melanoma is a two-week-wait pathway and MDT decision.

Treatment options

What may follow a positive biopsy.

Treatment is guided by the histological diagnosis - from a simple topical steroid regimen through to specialist gynae-oncology surgery and adjuvant treatment.

  • Ultrapotent topical steroid (lichen sclerosus)

    Clobetasol propionate is the mainstay for lichen sclerosus - reduces symptoms and cancer risk.

  • Imiquimod for VIN

    A topical immunomodulator used for selected cases of vulval intraepithelial neoplasia.

  • Wide local excision

    Surgical removal of VIN or early vulval cancer with a margin of healthy tissue.

  • Vulvectomy

    Partial or radical vulvectomy for larger or invasive vulval cancers.

  • Sentinel lymph node biopsy

    Assesses groin nodes in early invasive vulval cancer to guide further treatment.

  • Radiotherapy / chemoradiotherapy

    Definitive or adjuvant treatment for locally advanced or node-positive vulval cancer.

  • Structured gynae follow-up

    Long-term surveillance for lichen sclerosus, VIN and treated vulval cancer.

  • MDT review

    All confirmed vulval cancers and complex pre-cancers are discussed at a specialist gynae-oncology MDT.

Red flags

When a vulval biopsy is urgent.

The following presentations warrant urgent specialist review - and in most cases, an urgent two-week-wait pathway.

  • Vulval cancer

    Any suspected vulval cancer is an urgent two-week-wait referral.

  • Vulval melanoma

    Pigmented vulval lesions warrant urgent biopsy and MDT input.

  • High-grade VIN

    High-grade vulval intraepithelial neoplasia needs specialist treatment planning.

  • Immunosuppressed with VIN

    VIN in immunosuppressed patients progresses faster - closer surveillance is essential.

  • Prior high-grade CIN with vulval lesion

    A history of high-grade cervical disease raises the pre-test probability of VIN.

  • Persistent vulval ulcer

    Any non-healing vulval ulcer must be biopsied to exclude malignancy.

  • Post-menopausal vulval bleed

    Post-menopausal vulval bleeding is a red-flag symptom until proven otherwise.

  • Vulval Paget’s disease

    Extramammary Paget’s of the vulva is associated with underlying malignancy in a minority - full work-up is needed.

  • Vulval lichen sclerosus with new nodule

    A new nodule on lichen sclerosus raises concern for squamous cell carcinoma and must be biopsied.

Recognised by major UK insurers

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Frequently asked

Everything we get asked about vulval biopsy.

Quick answers on what to expect, pain, results and what happens next.

  • What is a vulval biopsy?

    A vulval biopsy is a small skin sample taken from a suspicious or persistent vulval lesion for histopathology. It is usually a 3–4 mm punch biopsy done under local anaesthetic in an outpatient clinic.

  • Does a vulval biopsy hurt?

    The injection of local anaesthetic stings briefly. Once the area is numb, the punch biopsy itself is painless. Mild soreness for a few days afterwards is normal and settles with simple analgesia.

  • How long does a vulval biopsy take?

    The procedure itself takes 10–15 minutes. Including consent, examination and after-care advice, allow around 30–45 minutes for the appointment.

  • When will I get the results?

    Histopathology results are typically available within 7–10 days and are discussed at a follow-up appointment or by phone with your gynaecologist.

  • What happens if the biopsy shows cancer?

    Confirmed vulval cancer is discussed at a specialist gynae-oncology multidisciplinary team meeting, and a structured plan - surgery, sentinel node biopsy, radiotherapy or chemoradiotherapy - is agreed with you.

  • Do I need to stop any medication before a vulval biopsy?

    Most patients do not need to stop routine medication. If you take anticoagulants such as warfarin, apixaban or clopidogrel, tell the clinic in advance so appropriate advice can be given.

Sources

Clinical guidelines we follow.

Published 2026-07-30 · Written by the Pulse Atlas editorial team · Next review 2027-07-30 · 4 min read

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In practice, in London

Booking vulval biopsy privately in London - what actually happens

With vulval biopsy, the London question is usually about report turnaround and the radiologist reading it - not whether the scan is available. The wait for vulval biopsy on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.

In practice, a private vulval biopsy appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For vulval biopsy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

There are a lot of consultants in London who can technically handle vulval biopsy. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which - and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.