We present a case of a 40-year-old woman with a history of human immunodeficiency virus infection and a nodular, hyperkeratotic 3.5-cm vulvar mass that increased in size over a 2-month period. Histopathologic examination of the excised mass was diagnostic of chronic hypertrophic vulvar herpes simulating neoplasia. Hypertrophic vulvar herpes presents a diagnostic challenge for both pathologists and clinicians because of its unusual clinicopathologic features that mimic neoplasia and its rarity. There is therefore the need for the correct diagnosis of this entity, so that appropriate therapy can be given. The pertinent literature is reviewed and discussed.