This is the case of a 56-year-old white woman with a medical history significant for chronic obstructive pulmonary disease, migraine, hypertension, tobacco abuse and hypercholesterolaemia. Her surgical history is significant for total hysterectomy and bilateral salpingo-oophorectomy for diffuse endometriosis. The patient presented with a vaginal lesion. The biopsy was positive for primary vaginal small cell carcinoma and human papilloma virus (HPV). Initial staging positron emission tomography (PET) scan confirmed stage 1 disease. The patient was started on chemotherapy with cisplatin and etoposide for four cycles, followed by concurrent chemotherapy with cisplatin/taxol and radiation therapy.