A Post-Menopausal woman complains of itching over labia majora for 4 years with minimal relief in itching with topical medication. On examination there is an indurated lesion over right labia with positive inguinal nodes. Most appropriate management is?: (A) Topical beclomethasone, (B) Topical estrogen with antibiotic, (C) Amoxicillin + clavulanic acid and follow up for lymph node status, (D) Biopsy
Answer is D. Intractable itching in Post-Menopausal age group with indurated lesion with inguinal lymph nodes appears to be a case of vulval carcinoma warranting a biopsy of the lesion.