Vulvar lesions consist of a wide array of benign, premalignant, and malignant lesions that involve the vulva. The decision to biopsy is determined by many factors including the time course of the lesion, uncertainty of diagnosis, symmetry of the lesion, irregularity of the borders, bleeding tendencies of the lesion, family history of vulvar malignancy, and patient concerns. All these factors independently play a role in the decision to biopsy.