This chapter covers benign, premalignant, and malignant neoplasms of the vagina. This includes epithelial tumors, mixed epithelial/mesenchymal tumors, lymphoid and myeloid tumors, melanocytic tumors, and a variety of other primary and secondary neoplasms that may involve the vagina. Many of the tumors that arise in the vagina are also seen in other lower genital sites, but the clinical features can differ in the vagina. Primary carcinoma of the vagina is rare and spread from cervical or vulvar primaries or metastatic disease must always be considered in the differential diagnosis.