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In order to get the most useful information from the biopsy, the site must be carefully chosen. In general, the edge of a lesion will give the most helpful histological information. The base of an ulcer or erosion is more likely to be non‐specific (Figure 7.1). If there is widespread change, with non‐uniform features, such as in extensive intra‐epithelial disease, multiple mapping biopsies may be required. These must be labelled correctly so that correlation with the original biopsy site is clear.

Most vulval biopsies are easily performed under local anaesthesia in the outpatient setting, but it is best to avoid biopsies of the clitoris, urethra, and anal margin. These patients should be referred to the relevant specialist – gynaecologist, urologist or colorectal surgeon – to consider biopsy under general anaesthetic.