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To assess the risk of Bartholin gland carcinoma in postmenopausal women.A referral patient population from a tertiary care cancer center and a hospital-based regional tumor registry was used in a case-control and retrospective cohort study. We searched for data on any discharge diagnosis or procedures involving the Bartholin gland, including excision, cystectomy, or marsupialization, and pathology reports confiming cancer diagnoses from a hospital-based regional tumor registry and a tertiary hospital's medical records department and operating room log.A total of 284 patients were identified, 161 patients from the hospital-based tumor registry and 123 from the tertiary hospital data bases. Pathology reports from 104 of the 161 patients with vulvar cancer were available and revealed two primary adenocarcinomas in postmenopausal women, one squamous cell carcinoma of the Bartholin gland in a postmenopausal woman, and two squamous cell carcinomas of the Bartholin gland in premenopausal patients over a 24-year period. Based on local New York State Department of Health census data, the incidence of Bartholin gland carcinoma was 0.023 per 100,000 woman-years in premenopausal women and 0.114 per 100,000 woman-years in postmenopausal women (incidence rate ratio 5.01, 95% confidence interval [CI] 0.67–25.1). The overall incidence rate of squamous cell vulvar carcinoma was 0.42 per 100,000 woman-years in premenopausal and 4.72 per 100,000 woman-years in postmenopausal women (odds ratio [OR] 11.55, 95% CI 7.82–17.14). The ratio of Bartholin gland cancer to other vulvar cancers was two per 37 in premenopausal women versus three per 124 in postmenopausal women (OR 2.3, 95% CI 0.39–17.9). Of thirteen postmenopausal patients (mean age 65.4 years) with Bartholin gland enlargement admitted to the tertiary care center, only four (30.8%) had excisions, whereas the remainder (69.2%) had drainage or marsupialization. None of the patients treated with drainage or marsupialization were listed subsequently in the tumor registry as developing Bartholin gland cancer during a median surveillance of 10.3 years (range 1.7–14.4).Bartholin gland cancer is exceedingly rare in all women, including postmenopausal women. We were unable to find evidence that would justify excision as the initial treatment of a Bartholin gland enlargement in postmenopausal women. Drainage and selective biopsy may be sufficient as initial management.