Vaginal neoplasia is one of the rarest of malignancies. Intraepithelial lesions are usually first identified by an abnormal Pap smear in a woman without a cervix. Surgery or ablation of the epithelium is usually highly successful. There have not been any findings of significance since 2003 to include in this review. Invasive cancer is usually located in the upper one-third of the vagina. If staged early, radical surgery can be curative as well as radiation therapy. Like cervical cancer, a more advanced stage is treated with radiation therapy, but with poorer survival rates than cervical cancer.