A Neglected Vulvar Ulcer with Unusual Huge Left Inguinal Lymph Node in a Postmenopausal Woman: A Case Report on Delayed Diagnosis of Carcinoma of the Vulva

Vulvar carcinoma is a relatively uncommon gynecological malignancy, accounting for approximately 5% of all female genital tract cancers and predominantly affects postmenopausal women. Survival rate observed to be approximated up to the 70% of cases, although with the presence of other comorbidities, it may worsen its morbidity and mortality. Magnificent appearance of either non healing ulcerative or inguinal mass ulcerated for those with diabetes cases could be contradicted as a persistent vulvar lesion and this may be associated with the delay in its diagnosis [1]. Case Presentation: We report the case of a 57-year-old multiparous (P7L5), postmenopausal woman who presented with a one-year history of progressive left vulvar swelling associated with intermittent pruritus, localized pain, and foul-smelling watery discharge. She also developed a progressively enlarging, painless swelling in the left inguinal region. Despite multiple consultations at peripheral health facilities over approximately six months, she received unspecified oral medications without symptom resolution. Physical examination revealed a large ulcerative lesion involving the left labia majora with extension toward the vaginal introitus and a markedly enlarged left inguinal lymph node. Punch biopsy performed on 14 April 2025 demonstrated Grade II invasive squamous cell carcinoma, and histopathology results were issued on 4 May 2025. The patient was referred to Ocean Road Cancer Institute for definitive staging and multidisciplinary management. Conclusion: Persistent vulvar symptoms or non-healing vulvar ulcers in postmenopausal women should prompt early biopsy. Delayed histological diagnosis may permit regional lymph node involvement, resulting in more advanced disease and poorer prognosis.