Vulvar cancer may spread as follows: By direct extension (eg, into the urethra, bladder, vagina, perineum, anus, or rectum) Hematogenously To the inguinal lymph nodes From the inguinal lymph nodes to the pelvic and para-aortic lymph nodes Diagnosis of Vulvar Cancer Biopsy Vulvar cancer may mimic sexually transmitted genital ulcers (eg, chancroid), basal cell carcinoma, vulvar Paget disease (a pale eczematoid lesion), Bartholin gland cyst or abscess, or condyloma acuminatum (genital wart).