What investigations are recommended for a patient with vulval lesions that are persistent or changing in appearance?

Recommended investigations for persistent or changing vulval lesions:

• Consider a suspected cancer pathway referral for any unexplained vulval lump or ulceration, or persistent vulval lesions that are changing in appearance.
• Clinical examination by a specialist is essential to assess the lesion and determine the need for biopsy or further diagnostic procedures.
• Biopsy of the lesion is typically required to establish a definitive diagnosis, especially to exclude vulval cancer.

These steps are recommended because persistent or changing vulval lesions may indicate malignancy, and early specialist assessment and biopsy are critical for diagnosis and management.

References: This approach aligns with the NICE guideline NG12 on suspected cancer recognition and referral, which advises suspected cancer pathway referral for unexplained vulval lumps or ulceration ¹.