Vulvar pathology often remains a challenge; biopsies are often challenging for the surgical pathologist. In this review, we outline the microanatomy of the vulvar region and examine some of the causes of vulvar erosions and ulcers. Primary ulcerative vulvar conditions such as Behçet disease, pyoderma gangrenosum, and infections are examined. We present an algorithmic approach to categorize vulvar dermatoses by pattern analysis as an interface, spongiotic, psoriasiform, lichen simplex chronicus, or vesiculobullous pattern. This approach uses established criteria similar to those that are used on nonvulvar skin. Finally, adequate clinical history and appropriate biopsy site selection are necessary to establish the correct diagnosis.