Melanoma/Skin Cancer&nbsp;&nbsp;&nbsp;

What is the appropriate radiation dose/volume for perianal basal cell carcinoma?

Should concurrent chemotherapy be given? How would you modify the regimen in elderly/frail patients?

Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?

Are there other settings where MRI is used for nerve assessment and radiation planning such as for certain definitive RT cases?

What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?

Have you utilized these gene-expression profiles in your practice? Is there sufficient data for this test to be used for clinical decisions?

How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?

Would you hypofractionate or be more conservative at 2 Gy per fraction? Would your management be affected knowing the patient is on hydroxyurea?

8 Answers available

In patients with skin squamous cell carcinoma invading the skull, what dose do you limit the brain when treating definitively with radiation?

Which patients with cSCC could you omit adjuvant radiation following pathologic complete response following cemiplimab?

When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?

How would you manage a cardiac metastasis from Merkel cell carcinoma?

The patient has an asymptomatic metastasis in the left atrial appendage. Would you start off with immunotherapy then add radiation later, or visa ver...

Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?

How would you palliate a large, symptomatic vaginal melanoma recurrence with limited small pelvic lymph node metastases?

Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...

In patients with multiple basal cell carcinoma lesions on vismodegib, would you hold vismodegib while delivering radiation therapy to one locally advanced BCC lesion that was not amenable to surgery?

What is the preferred dose and fractionation regimen for cutaneous squamous cell carcinoma of the thumb?

How would your treatment change for definitive vs post-surgical RT? Does approach differ depending on the anatomic (distal vs proximal and dorsal vs ...

What are the indications for postoperative radiation for extramammary Paget's disease?

What dose and fractionation do you utilize? Would your recommendations differ considering the site of disease is at the penile base/suprapubic region?

What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?

Burnmeister data from 2012 showed a local control benefit for radiation therapy in selected patients, but that was without immunotherapy. Is adjuvant ...

What dose-fractionation would you recommend for a small basal cell carcinoma of the nasal ala in a patient with poor performance status or transportation difficulties?

5 Answers available

What goes into your decision making when deciding between superficial radiation and Mohs surgery for cutaneous squamous cell carcinoma of the head and neck?

Size: 3 cm, cN0

How would you approach the post-operative radiation treatment volumes for a Merkel cell carcinoma of the hand?

Would you treat the primary site alone, include the hand and arm lymphatics to the epitrochlear nodes (one continious treatment volume from hand to el...

What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?

Is T4 disease a contraindication?

What is your approach to treating inoperable mucosal melanoma of the head and neck region?

What is the preferred dose, fractionation, and role of concurrent chemo?

What radiation dose-fractionation regimen would you choose for squamous cell carcinoma of the great toe in a patient who declines surgery?

How would you counsel the patient on wound healing and potential complications in this region?

How do you manage SCC metastasis to the parotid with unknown primary?

How would your management change in an elderly patient with no surgery verus superficial parotidectomy or total parotidectomy?

Would you consider adjuvant radiation for a patient with recurrent pelvic node melanoma s/p immunotherapy and pelvic lymph node dissection with complete pathological response (only necrotic tissue; no viable melanoma)?

What ENI/lymph node stations would you treat for a locally advanced SCC of the thumb?

How would you approach a recurrent, cutaneous SCC of the face with high-risk features s/p resection?

Definitive radiation therapy > 5 years ago. Positive margins, PNI of 0.1 mm. What volume would you cover? Dose/fractionation?

How do you approach an elderly patient (~80 years) with stage IIC melanoma post resection with oligometastatic brain lesion post intracranial resection which developed 2 years after treatment?

The patient's current PET scan showed no systemic disease. Due to his age, there is a concern of whether the patient would tolerate dual immunotherapy...

How would you treat an elderly patient (ECOG 0-1) with locally advanced rectal cancer and synchronous Merkel cell cancer of the extremity requiring adjuvant RT?

Would you treat both at the same time? Does one need to be prioritized over the other? Does Xeloda have any efficacy against Merkel cell cancer? How...

How would you manage a Merkel cell carcinoma that spontaneously regressed clinically in a patient medically high-risk for surgical resection/anesthesia?

How would you treat the primary tumor (located in the chest)? Would you treat the regional lymph nodes?

How would you treat a periungual squamous cell carcinoma of the thumb?

What is your preferred skin surface maximum dose constraint for skin brachytherapy?

How would you approach a patient with clinical T3N1 anorectal malignant melanoma referred by a surgeon for neoadjuvant therapy?

Is there a potential role for concurrent radiation therapy? What if the tumor is BRAF mutated?

What electron beam dose/fractionation would you use for a recurrence basal cell carcinoma of the scalp adjacent to a split thickness skin graft?

For merkel cell carcinoma of the eyelid, how do you approach post-operative management and what are the recommended radiation treatment volumes?

How do you approach the management of basal cell carcinoma with single lymph node involvement?

In patients with no apparent skin involvement but lymph-node showing basal cell carcinoma with extracapsular extension. Would this warrant radiation o...

Do your radiation treatment margins change for cutaneous basal cell carcinoma in the adjuvant setting compared to cutaneous squamous cell carcinoma?

What margins do you use for each cancer for photons vs electrons? If your margins differ between cBCC and cSCC, why?

Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?

Majority of patients on the seminal trial (Gross et al., PMID 36094839) had tumors isolated to head & neck, what was the rationale for this?

Would you continue cemiplimab or pembrolizumab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma?

Do you base your decision on extent of residual disease? Does the use of (neo)adjuvant immunotherapy have an impact on surgical site size or he...

Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?

Is a placebo-controlled trial anticipated?

6 Answers available

Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?

How would you treat an SCC of the helix of the ear with posterior auricular nerve involvement s/p surgical resection?

If there are no pre-op photos, what would your fields look like and dose/fractionation?

How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?

If the patient had no nodal sampling, would this influence your decision?

Is close observation a reasonable option for elderly patients with a small basal cell carcinoma of the face?

How would you approach a patient with malignant spindle cell neoplasm of the scalp excised with a focally positive deep margin?

What dose and margins would you use? The patient is s/p a liver transplant on immunosuppression.

How would you treat a melanoma of the penile skin in a medically inoperable patient?

If radiation, what dose/fractionation and technique?

In what scenario would you add systemic therapy with adjuvant radiation therapy in resected, locally-advanced, cutaneous squamous cell carcinoma?

Reference: TROG 05.01 Trial

Would you consider adjuvant radiation in a patient with stage 1 (<1 cm) Merkel cell carcinoma of the lateral upper arm status post resection to negative wide margins?

Sentinel lymph node assessment was negative and there are no other high risk features.

Do you hold mTOR inhibitors during radiation?

If so, how long pre- and post-RT?

What dose-fractionation would you use for cutaneous head and neck squamous cell carcinoma status post resection and skin grafting?

Would you offer adjuvant hypofractionated radiation therapy over a graft in the HN region?

Would you offer radiation therapy post lumpectomy for a small melanoma oligometastasis with negative margins?

If so, would you favor 30 Gy/5 fraction accelerated partial breast irradiation?

Are there any situations in which you would treat a cutaneous in-situ squamous cell carcinoma of the head and neck with radiation?

What is the significance of PNI in cutaneous BCC?

What level of PNI is considered "large nerve" in this disease?

How do you treat non-melanomatous skin cancers in poorly vascularized tissue?

This is an elderly patient with a BCC/SCC over the shin who is not eligible for Mohs due to concern for wound-healing issues. Orthovoltage/superficial...

In a patient with solitary metastasis skin/subcutaneous wrist, resected with graft, from a primary breast angiosarcoma, what would be your preferred fields and dose?

50+ yo F. Mastectomy, chemo, and RT in 2016 for primary breast angiosarcoma, not RT induced. Had longstanding cyst on wrist, biopsied, and positive fo...

Do you consider a solitary IHC+ sentinel inguinal node lymph node to have the same implication for treatment as a single positive node or multiple positive nodes?

Pt with 1.3 cm Merkel cell (buttock) excised with negative margins. Two sentinel inguinal nodes sampled and one is IHC+.

What would your radiation volume be for a patient with SCC just medial to the infraorbital foramen with positive PNI who presented with pain s/p regional excision?

Post-operative MRI focused on CN V was negative. There is a focal positive margin.

How would you approach a cutaneous squamous cell carcinoma with primary tumor completely excised, but multiple foci of LVI at the peripheral specimen margin and no other high-risk features?

Would you consider re-excision and/or adjuvant RT? If RT, what margins on the scar and treatment volume would you use?

When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?

Would you irradiate elective lymph nodes for a T1 Merkel cell carcinoma of the head and neck with a negative sentinel lymph node?

Would a history of immunosuppression impact your decision?

What dose would you use for re-irradiation of metastatic melanoma to an inguinal node?

If the inguinal node was previously treated with SBRT 30Gy/5fx and immunotherapy >6 months, what treatment would you recommend?

Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?

Would you offer adjuvant radiation for a sebaceous carcinoma of head and neck after wide local excision?

LVSI positive. No other high-risk features. Would you cover lymphatics?

How would you manage the axilla in a patient with Merkel cell carcinoma of the left forearm with clinically negative, axillary sentinel node positive disease?

Would you recommend axillary dissection, axillary dissection followed by adjuvant radiation, or axillary radiation alone? Does the number of positive ...

Do you treat the ipsilateral neck and primary site for a resected skin cancer with parotid mets?

If the only indication were the parotid mets (primary site resected with no high risk features) would you treat the parotid and neck (assuming skin ca...

Would you offer adjuvant radiotherapy to an elderly patient with T4 SCC of the scalp and positive margins 6 months after Mohs surgery?

Would you offer RT if there was bone invasion? If there was poor wound healing causing a 6 months delay, would you still offer RT?

Would you include interconnecting skin in the radiation volume for a patient with lateral forehead squamous cell carcinoma who will receive radiation to the surgical bed and preauricular lymph nodes?

Would you consider lymph node basin radiation in a patient with upper extremity Merkel cell carcinoma with one positive SLN but with no other positive lymph nodes found on axillary dissection?

How would you approach treatment of an elderly patient with recurrent atypical fibroxanthoma (malignant spindle cell neoplasm) after Mohs surgery?

What is the role for surgery vs RT?

What dose/fractionation would you consider for SBRT of uveal melanomas too large for plaque brachytherapy?

How would you manage eccrine porocarcinoma of the great toe with positive superficial groin and pelvic lymph nodes s/p toe amputation and pelvic lymph node dissection?

Would you offer systemic therapy and/or radiation therapy to groin/pelvis?

What is the role of radiotherapy in medically inoperable, large and or recurrent aggressive basal cell or squamous cell cancer of the skin in high risk areas?

Should definitive radiotherapy be used as a standard approach? If so, what are the dose and technique considerations in treating these complicated tum...

Would you ever consider SBRT for de novo cutaneous squamous cell carcinoma?

Is there any data to support it? What dose/fractionation would you consider?

What radiation regimen do you use to palliate bulky melanoma metastases involving the oral cavity?

In this case, I have a patient with widely metastatic cutaneous melanoma (BRAF wild type, NRAS mutated) who is progressing through pembrolizumab and i...

When would you add an extra radiation dose to compensate for treatment breaks?

Apart from H&N SCC, are there times where adding an extra dose of radiation due to a tx break is appropriate? Is there a decent equatio...

How would you treat a high risk Merkel cell carcinoma of the lower leg after R1 re-resection who failed sentinel mapping?

Would you treat the primary site only, include popliteal nodes, or include popliteal and inguinal nodes?

What is the role of radiation therapy in a patient with diffuse cutaneous melanoma metastases who cannot tolerate systemic therapy?

What is your preferred radiation therapy technique for treating resected neurotropic squamous cell carcinoma of the facial skin situated near the infraorbital foramen?

How would you treat an immunosuppressed patient with high risk cutaneous SCC of the axilla with node positivity on axillary node dissection?

What radiation doses would you use for the scar and axillary nodal regions? Should supraclavicular and/or IMNs be covered?

In what clinical circumstances would you consider re-irradiation for skin cancer?

Would you choose re-treatment with electrons, photons, or brachytherapy? What dose and fractionation scheme would you employ?

How would you manage a nodal recurrence of cutaneous SCC if the patient is unable to receive surgery for 6-8 weeks?

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

How do you approach selection of dose and fractionation for definitive treatment of localized skin cancers?

With so many choices listed in NCCN guidelines ranging from 2-7 weeks, what considerations factor into your decision making?

How do you approach breast conserving therapy in a woman who has formed bothersome keloids after prior surgeries?

Is there any alteration in approach from the medical, surgical, or radiation oncology perspective that can mitigate the risk of forming keloids withou...

How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?

How would you approach radiation treatment of recurrent, BRAF-negative melanoma with left distal leg metastases and two isolated PET-avid inguinal nodes?

The index lesion was located inferior to the left knee and excised appropriately, with an additional in-transit metastasis in the left mid leg. The pa...

How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?

What is the role and sequence of surgery and/or RT? Which nodal levels would you include in your RT field(s)?

How do you approach treatment for a patient with uveal melanoma who is not a candidate for plaque brachytherapy

What are the surgical and radiation options? What dose and fractionation scheme is appropriate for fractionated SRS?

How would you manage recurrent popliteal and inguinal LNs from melanoma?

In a patient with a history of a RLE melanoma s/p WLE and right ILND, how would you treat nodal recurrence? What are the surgical vs non-surgical opt...

How would you treat a patient with an keratoacanthoma of the right nasal ala?

What approaches (surgical vs non-surgical) offer the best cosmesis for keratoacanthoma (low grade squamous cell carcinoma) ?

How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?

Is there a role for radiation? Does your approach differ depending on site(s) of disease, and/or if the patient has Basal-Cell Nevus (Gorlin) sy...

How do you advise patients on the risk for permanent alopecia following RT to the scalp?

In treating skin cancers of the scalp, are there any specific constraints you give to the skin itself to prevent alopecia? How does changi...

How would you approach the treatment of a patient with a history of cutaneous melanoma and only overt site of disease being a bulky level III axillary lymph node?

Specifically, this patient was unable to tolerate immunotherapy due to severe side effects.

Would you offer definitive radiation therapy for a Merkel cell carcinoma in which surgical resection would be disfiguring or result in significant dysfunction?

In general, how would you approach such a case with regards to creation of your treatment volumes and dose-fractionation?

For Merkel cell carcinoma of the lower extremity with early isolated recurrence in the ipsilateral inguinal nodes, would you include pelvic lymph nodes in the post-operative field following inguinal lymph node dissection?

How would you approach a BRAF negative metastatic melanoma patient on immune checkpoint inhibitor therapy with enlarging, symptomatic brain lesions that had previously been treated with SRS?

If on pembrolizumab or nivolumab, when would you escalate to ipilimumab/nivolumab?

What is your preferred radiotherapy regimen for palliative treatment of cutaneous T cell lymphoma?

How would you manage a small recurrent melanoma of the lower eyelid in a patient deemed inoperable?

Would you recommend radiation therapy or immunotherapy? If proceeding with radiation therapy, what dose-fractionation and technique would you utilize?

Would you recommend post-op RT for an ulcerated Clark's level IV melanoma of the zygomatic/preauricular region following a WLE with diffuse melanoma in-situ at the margins?

What dose-fractionation schedule would you utilize?

Would you treat a locally advanced head and neck cutaneous squamous cell carcinoma with axillary-only mets definitively?

Would you treat with radiation (+/- surgery upfront, if resectable) or systemic therapy?

What is your approach to adjuvant radiation for anorectal mucosal melanoma s/p wide local excision?

What dose, fractionation and what elective coverage do you recommend?

What is your approach to elective radiation of the neck with primary cutaneous squamous cell carcinoma?

When do you electively treat the ipsilateral versus ipsi- and contralateral neck?

How would you approach the treatment of a low grade adnexal carcinoma of the scalp in a patient with prior history of WBRT as a child?

This particular case involves a patient with a frontal scalp low grade eccrine carcinoma status-post excision with positive margin complicated by...

What dose-fractionation and technique do you use when treating lentigo maligna?

What is your preferred setup/immobilization for patients with cutaneous malignancy of the toe involving the medial aspect of the digit?

What dose and fractionation would you use for definitive intent radiation therapy for a metastatic melanoma of the maxillary sinus?

How would you approach treatment of residual melanoma in situ of the perianal skin?

Would you recommend adjuvant radiotherapy for a patient with positive margins for in situ disease with negative margins for invasive disease? If so, w...

Is postoperative radiotherapy indicated for a primary parotid gland melanoma?

Would there be any indication for postoperative RT if cervical lymph nodes are negative?

How do you decide between initial radiotherapy vs systemic therapy in patients with metastatic melanoma and brain metastases?

If neurologic symptoms are absent or controlled, does that affect your treatment decision?

How would you treat a bulky axillary squamous cell carcinoma of unknown primary in an elderly person?

Assuming no other sites of disease on staging scans, surgery is not an option, and the patient is otherwise healthy with reasonable life expectancy. W...

Would you consider post-operative radiation therapy for resected malignant melanoma with in-transit metastasis?

In this example, the patient had a resected melanoma with negative margins and the specimen was noted to have two nests of tumor cells in the deep der...

Would you consider starting immunotherapy concurrently with whole brain radiation for newly diagnosed metastatic (BRAF negative) melanoma with multifocal symptomatic brain metastases?

If so, would you consider it with monotherapy only or also with combined checkpoint blockade?

Would you offer adjuvant RT for a small merkel cell carcinoma of the lateral canthus with a close margin?

Given the location but no other high risk features would you offer RT? If so, what dose and fields?

Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?

What dose of radiation, what type of chemo, and what indications?

What are the alternatives to gonioscopy gel to protect the cornea when using internal eye shielding?

In patients with cancers involving the lid requiring superficial x-ray treatment, I use an internal eye shield placed under the lid to protect the cor...

What dose-fractionation would you utilize for an unresectable localized cutaneous melanoma that has progressed on immunotherapy?

Specifically, for a melanoma of the axilla with proximity to the brachial plexus, how would you approach such a case to minimize chance of radiation-i...

What dose-fractionation would you recommend for post-operative radiation therapy for an excised cutaneous squamous cell carcinoma of the foot with a skin graft?

Is there an appropriate hypofractionated regimen for such a clinical scenario?

What is the most appropriate dose-fractionation for an early stage, progressive cutaneous squamous cell carcinoma of the nose in an elderly/frail patient in the setting of the COVID-19 pandemic?

How do counsel patients regarding potential for cartilage necrosis?

5 Answers available

If small cell carcinoma was found in an axillary lymph node with an unknown primary, would you recommend axillary lymph node dissection prior to chemoradiation?

What would your dosing recommendation be?

Would you recommend adjuvant radiation for an atypical fibroxanthoma of the scalp that is completed resected with +PNI and +LVI?

What pathologic features are most important when evaluating the possible need for adjuvant therapy?

How do you measure the skin dose when you are concerned about dosing to the skin?

Is it possible to get a good measurement with TLDs? TLDs can overestimate the surface dose by 10 - 40%. Do you use a skin diode measurement on the fir...

What is your preferred dose-fractionation regimen when treating high-risk SCC of the skin in elderly and/or frail patients?

How would you manage a high risk SCC of the scalp that has wound healing issues after Mohs surgery?

Would you offer RT? If so, shat dose fractionation do you recommend?

When should proton beam therapy be considered for uveal melanoma?

Are there exclusion criteria?

Is there a maximum time delay in offering adjuvant radiation to patients with wound healing issues for sarcoma and skin cancer patients with aggressive histology and positive margins?

Sometimes wound healing can delay adjuvant radiotherapy by several months. For aggressive histology, such as high grade sarcomas or skin cancers with&...

Would you offer adjuvant radiation to the surgical bed for a Merkel cell carcinoma of the upper extremity with low-risk features as per the NCCN Guidelines?

*Negative margins, <1cm in size, no LVI, negative SLNB, not immunocompromised, no prior surgery (as well as a negative PET/CT scan).

What radiation dose, fractionation and volume would you use in an elderly patient with localized extensive anorectal malignant melanoma status post laparoscopic APR?

Would your recommendation change with the following aggressive features: 8 cm, pericolic extension, positive radial margin, perineural invasion presen...

What dose-fractionation would you use for a recurrent basal cell carcinoma of the right ear concha close to the tympanic membrane status-post multiple Mohs surgeries with close/positive margins?

Further resection is not recommended, as the surgeon is worried about damaging hearing with additional surgery.

How do you account for tumor growth from pre-operative to intra-operative ultrasound for uveal melanoma?

Do you prescribe to 5mm/apex or use a margin? Do you add time for tumor growth or allow less than the prescription dose to the apex?

Are there guidlines for elective coverage of nodal basins in head and neck for skin cancer removed in the area?

What dose-fractionation do you use for recurrent SCC (face) that was previously multiply resected and radiated, but has a persistently positive margin after re-resection?

Especially in the setting of prior “standard” adjuvant dose and refusal of the patient to undergo more extensive surgery. Do you recommend...

For clinically node negative large squamous cell carcinomas of the scalp vertex, would you electively treat the nodes?

If so, which levels? Bilateral? What about parotids or submandibular gland?

How do you prevent non-healing ulcer when treating patients with cutaneous SCC of the distal lower extremity who have peripheral vascular disease?

These patients are often not surgical candidates, but radiation complications may also be underappreciated. Do you refer to vascular surgery pri...

When is postoperative radiation indicated after enucleation of an ocular melanoma?

Is extrascleral extension or optic nerve invasion an indication? I can find little in the literature or textbooks discussing this issue, likely ...

What are your dose constraints for treating axillary nodal basin in melanoma with 30Gy/5fx?

What are your dose constraints for treating axillary nodal basin in melanoma with the Ballo protocol 30Gy/5fx?

Is there a role for treating actinic keratosis with superficial radiation therapy to widespread areas on scalp?

If so, what is your suggested dose/fractionation?

Is there a role for radiation in the treatment of bulky axillary adenopathy in patients with newly diagnosed oligometastatic melanoma?

Should these patients have surgery if resectable? Should RT (SBRT) be directed at metastases during/concurrently with immunotherapy down the road?&nbs...

Would you recommend surgery +/- adjuvant XRT or definitive XRT in elderly patients with recurrent squamous cell carcinoma of the ear with direct invasion through the cartilage of the helix?

What is the role of adjuvant radiation therapy for isolated melanoma lymph node metastases, status post resection and found to have extranodal extension?

What would be your recommended adjuvant treatment approach for a completely excised lymphoepithelial carcinoma of the right nose recurrent in a left level IB lymph node, status-post excisional biopsy?

Would you recommend additional surgery for the violated neck? Or, would you proceed with adjuvant radiation therapy? If so, would you treat ipsilatera...

How would you approach adjuvant radiation therapy for a Merkel cell carcinoma of the cheek in an immunocompromised patient?

For example, in a patient status-post WLE with a close (2.5 mm) deep margin and negative neck node sampling, would clinical (but not pathologic) ...

What dose and fractionation would you recommend for treating the primary site of a patient with metastatic anal melanoma?

What do you consider to be the regional nodal bed for a Merkel cell carcinoma of the thigh with a positive sentinel node in the inguinal chain?

Would you also radiate the ipsalateral external and/or common iliac nodes?

In what situations would you treat elective regional lymph nodes for a squamous cell carcinoma of the skin on the extremity/trunk that was clinically node negative?

For example, for a squamous cell carcinoma of the forearm treated with Mohs surgery with negative margins, are there features that would lead you to e...

When is adjuvant radiotherapy recommended for a high risk squamous cell carcinoma of the skin (non-H&N) if the tumor is resected with widely negative margins and there is no perineural invasion?

Per NCCN, only +/close margins and +PNI are given as indications for adjuvant RT. However, are the presence of other risks factors considered to guide...

How long after achieving a CR would you consider stopping pembrolizumab in metastatic melanoma?

Is there a role for radiation therapy if squamous cell carcinoma (SCC) is incidentally found in an excised epidermoid cyst?

If the cyst was encapsulated and completely removed and SCC was found incidentally on final pathology, what are some factors that would influence your...

What are the indications for adjuvant radiotherapy for basal cell carcinoma of the skin of the head and neck?

NCCN lists only substantial perineural invasion. What about other high-risk adverse features such as histologic subtype, multiple recurrences, d...

What dose fractionation would you recommend for large (>5 cm) perianal Bowen's disease (squamous cell CIS)?

What postop volume would you treat for for cutaneous squamous cell carcinoma of the upper neck with perineural invasion of multiple nerves?

Should nodes always be covered for perineural invasion when that is the only risk factor?

What dose-fractionation would you use to treat a single large melanoma lung metastasis?

How does your fractionation choice change if the lesion is abutting the pleura?

Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?

These patients have been largely excluded from these trials. What if the infection is well controlled?

What risk factors prompt you to treat an early-stage nasal squamous cell carcinoma of the skin with post-operative radiation to the primary and/or elective nodal radiation?

When elective nodal radiation is recommended, which nodes would you treat (i.e. facial, pre-auricular, peri-parotid, levels I-III, etc.)?

Would you offer adjuvant radiation for a <1 cm preauricular sebaceous carcinoma after wide local excision?

Patient underwent a shave biopsy of a 6x5x2mm preauricular lesion that showed moderatley differentiated sebaceous carcinoma with deep and lateral marg...

Would you recommend adjuvant radiation therapy to the locoregional lymph node basins for Merkel cell carcinoma (MCC) with a solitary macroscopically positive lymph node (LN) without ECE after lymph node dissection?

Per the NCCN guidelines, in this specific scenario, adjuvant radiation therapy to the locoregional lymph nodes after lymph node dissection is not indi...

How do you manage the elective lymphatics in high risk squamous cell carcinoma of the skin?

In a clinical N0 patient with high risk (large, deeply invasive, poorly differentiated, +PNI, etc) cutaneous SCC of the head and neck, who do you...

How do you decide whether or not to cover elective lymphatics when treating cutaneous squamous cell carcinoma of the head and neck with definitive RT?

Unlike in post-operative cases, you lack detailed pathologic information in this scenario. Do you base your decision on location, size, and/or patholo...

How would you manage treatment of keloid that is so large it requests a graft?

What dose/fractionation would yield the lowest risk of graft failure? Does your treatment management change based of location, ex the ear vs back?

Do you recommend elective lymph node irradiation for a basal cell carcinoma of the skin that is deeply invading muscle?

For example, would you recommend treatment of the cervical and posterior occipital lymphatics for a 4 cm lesion deeply invading the posterior ridge of...

What is your preferred approach for the management of choroidal oligometastases?

How do you decide between plaque brachytherapy and external beam approaches? What dose do you use for plaque brachytherapy? For external beam, what do...

How would you utilize adjuvant radiation therapy in a patient with a cutaneous spindle cell neoplasm of the scalp metastatic to the parotid gland?

What dose-fractionation schedule and treatment volumes would you utilize for adjuvant radiation therapy status-post total parotidectomy with negative ...

How do you manage the neck in patients with cutaneous SCC who are at high risk of nodal disease but had a negative neck dissection?

Is there a minimum amount of nodes you would like to be removed before you omit radiation to the neck? Do you consider other factors when deciding whe...

Is there an effective treatment for multiple appearances of cutaneous Kaposi's lesions besides radiation?

In a patient who already received 13 courses of radiation (with complete response), is there any other effective treatment?

Should lymph nodes be treated with postop RT of undifferentiated pleomorphic sarcoma of the head and neck?

Specifically, the cheek? If so, which nodes should be treated and to what dose?

In which patients do you offer adjuvant radiation for porocarcinoma?

If a patient has undergone wide local excision with residual disease, but negative margins, is it safe to observe? If adjuvant treatment is indicated,...

How do you manage anticoagulation for patients with DVT/PE who have brain metastases?

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is t...

How do you treat multi-focal/diffuse non-melanomatous skin cancers of the face and scalp for which you would also want to cover high-risk elective nodes?

Would you treat large/total scalp fields to definitive skin cancer doses? If the patient has a more limited KPS, would you treat sequentially in order...

Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?

Would your recommendations change if it was a partial vs complete radiographic response?

What is your approach to adjuvant treatment to the tumor bed and/or regional lymph nodes for an early stage Merkel cell carcinoma status-post WLE and sentinel lymph node biopsy?

If there is an operationally failed sentinel lymph node biopsy, do you always include RT to regional nodes?

Do you have a tolerance dose for a skin graft when treating a high-risk skin cancer?

How long would you typically wait between date of surgery and initiation of radiation therapy? What factors influence this decision?

Do you offer radiation in the setting of a resected desmoplastic melanoma with negative margins given that several retrospective studies show a local control benefit?

If so, how large of a margin would you place on the primary lesion and would you incorporate any adjacent lymph node levels?

Do you recommend using altered fractionation for a patient with squamous cell carcinoma of the skin in the head and neck region who cannot receive concurrent chemotherapy?

For example, if you had an octogenarian with a previously resected squamous cell carcinoma of the skin who presented with metastases to the parotid an...

How do you manage an acute herpes zoster infection (shingles) in a radiation therapy treatment field where the skin is getting a significant dose of RT?

Do you give a treatment break? Is so, how long should RT be held? Are there skin management techniques to use?

For a localized hidradenocarcinoma of the extremity managed with resection, what adjuvant dose to the surgical bed would you recommend?

Would this recommendation change based on proximity to a joint?

When does perineural invasion for a squamous cell carcinoma of the skin of the head and neck merit adjuvant radiotherapy?

Following Mohs surgery and in the absence of other high risk features, do you offer RT for any PNI? A single nerve < 0.1 mm? A single ne...

How would you treat an unresectable SCC of the skin local recurrence in the base of skull with clinical and radiographic CN involvement?

Would you be comfortable with 55Gy in 20 fractions around the optic nerves and brainstem, or would you treat with a more protracted fractionation? Do ...

What is the best management for recurrent basal cell carcinoma after prior radiation and vismodegib?

Would re-irradiation be an appropriate option? What dose/field would you incorporate? If treating with standard fractionation, would you take the enti...

How do you manage an open wound that is not healing after radiation treatment for an ulcerated SCC of the scalp?

If the patient is a poor surgical candidate and is a symptomatic, can he or she live with this?

How do you address the risks of radiation-induced carcinogenesis when counseling younger adult patients (40-60 years old) on definitive radiation therapy for non-melanomatous skin cancer of the head/neck?

Is there an age where the patient would be considered "too young" to receive definitive radiation therapy as opposed to surgery?

How should RT be combined with immunotherapy to generate an abscopal response?

Is there any consensus regarding the optimal RT dose, fractionation, and timing to the best abscopal response? What is the optimal metastatic site to ...

Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?

If so, what is your treatment volume?

When treating a high risk cutaneous squamous cell carcinoma post-operatively to the tumor bed, do you include the entire pre-op tumor in your PTV or do you include only the scar with margin?

For example, if a 5 x 5 cm squamaous cell carcinoma with deep invasion has been resected via Mohs with negative margins, will your PTV include the ent...

What dose and fractionation do you use when you want an abbreviated course for incompletely resected squamous cell carcinoma of the pre-auricular area?

For example, in a demented, poor performance status, elderly patient?

What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?

Is modern surgical/reconstruction treatment superior to radiation therapy? If contact brachytherapy or superficial (orthovoltage) therapy isnt possib...

Do you treat the surrounding erythema for cutaneous squamous or basal cell carcinoma?

Is the surrounding erythema as part of the GTV so that the margin is placed around the erythema rather than around the gross lesion only?

What dose do you typically use when retreating locally aggressive and recurrent SCCs of the scalp (with no regional or distant mets)?

Assume all other options have been exhausted or are not feasible (e.g. systemic treatments, medically inoperable, etc.). Is there a BED or EQD2 that y...

What is the best radiation technique for treating Kaposi sarcoma involving the irregular surfaces of the toes and soles of the feet?

For cutaneous SCC of the cheek with microscopic PNI, which nodal levels, if any, do you prophylactically treat?

Do you prophylactically treat the entire parotid gland as well?

How do you best palliate metastatic skin and subcutaneous melanoma lesions?

Do you hypofractionate or add any concurrent systemic therapy? What specific dose-fractionation regimens do you recommend?

Is there any data to support radiation and targeted agents (Braf inhibitor or ipilimumab) combined for stage III melanoma?

Even though data from TROG 02.01 showed 52% decrease in LR, I've heard some argue that toxicity is increased and that "it damages the blood vessels an...