Twenty-three cases of malignant melanoma of tile vulva recorded at Roswell Park Memorial Institute over a 36- year period have been reviewed. The findings confirm those of earlier series that these lesions tend to occur in postmenopausal Caucasians and most commonly originate on the labia minora and clitoris. Twenty of 23 patients were treated with therapy more conservative than radical vulvectomy and regional node dissection, with a resultant 25% 5-year survival and 10% 10-year survival among eligible patients. The fact that 12 of 1-1 recurrences were on the vulva or in inguinal nodes argues for primary surgical removal of these structures. No patient in this series with a lesion greater than 2 cm or with clinically positive groin nodes survived 5 years. According to the literature, very few patients with groin node involvement have survived, even with radical surgical therapy, and a combination of therapeutic modalities in treating these patients is recommended.