Vulvar malignancies are rarely encountered in dermatology, yet it is imperative to develop a thorough clinical and diagnostic acumen, as early detection and appropriate treatment can improve quality of life or even prevent fatal outcome. The common premalignant vulvar lesions are vulvar intraepithelial neoplasia (VIN), vulvar Paget’s disease, and melanoma in situ. These are notable since they are associated with a high post-treatment recurrence rate. The incidence of VIN is increasing in younger women. Early diagnosis and tailoring the management on individual basis may help to reduce the long-term morbidity. This review describes etiology, clinical features, management, and prognosis of vulvar premalignancies.