Background: Vulval Keratoacanthoma (KA) is very rare and its differential diagnosis from the commonly occurring Vulval Squamous Cell Carcinoma (SCC) is important to avoid overtreatment. Case: A case of Vulval KA in a 79-year-old lady is reported. She presented with a 9-mm firm raised lesion on the antero-lateral left side of the clitoris of a few months' duration with no associated symptoms. The lesion was resected with clear margins and the excision site was well healed at her appointment 4 weeks later. Conclusion: We share our experience reporting the fifth case of a vulval KA in the world literature. Consideration to the occurrence of vulval KA is important to avoid both an erroneous diagnosis of vulval SCC and the associated consequences of radical surgery.