<prompt> 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?Topical beclomethasoneTopical estrogen with antibioticAmoxicillin clavulanic acid and follow up for lymph node statusBiopsy  <response>: 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. 