Vaginal melanoma should be differentiated from other rare melanoma-containing tumors such as pigmented neurofibroma and malignant nerve sheath tumors. The cell types of vaginal melanoma are diverse, and in particular, anaplastic vaginal melanoma is easily misdiagnosed with vaginal squamous carcinoma, vaginal adenocarcinoma, and sarcoma, with a misdiagnosis rate of 20%. It is mainly distinguished from other diseases by immunohistochemical staining and electron microscopy, which is more accurate than HMB-45 staining. Differentiation from the rare vaginal mucosal melanoma and exclusion of metastases from other sites and invasion of malignant melanoma from adjacent organs should also be thought of, and changes at the mucosal junction are the most reliable basis for proving the primary. Vaginal melanoma has a typical clinical presentation. Clinical diagnosis is more easily obtained when vaginal lesions are found on gynecologic physical examination, and pathologic examination can be performed by perforated biopsy or excision of whole lesions in suspicious cases. The cut edge includes 1 to 2 cm of normal vaginal mucosa to prevent the spread of the tumor during biopsy, and the excised tissue is confirmed by rapid freezing to expand the scope of the procedure according to the situation. Non-epithelial malignant tumor cells are seen on the smear.