Could this vulval lump be malignant?

Case scenario

Jane, a 46-year-old housewife, presented with a six-month history of a vulval lump that she had first noticed when washing herself. The lump was nontender, 1 cm in diameter and situated on the right labium majus (Figure 1). It had a red spot over the surface and was mobile, but it was not itchy and had not bled. There was no lymphadenopathy in either groin.

The patient’s general health was good. She continued to menstruate regularly and had undergone a tubal ligation five years previously. A recent mammogram had been reported as normal and her most recent cervical smear (taken 12 months previously) was also reported as normal. She was not taking any medications.

A general examination was unremarkable and the patient’s vital signs were normal. Apart from the vulval lump, her gynaecological examination was unremarkable.