This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Vulvar cancer, Subject name: Gynaecology & Obstetrics
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? 
Select and explain. 
A. Topical beclomethasone, B. Topical estrogen with antibiotic, C. Amoxicillin + clavulanic acid and follow up for lymph node status, D. Biopsy
D: Biopsy
Answer: D: Biopsy 
Explanation: 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.