How do you manage an anal SCC status post a non-oncologic excision of a 2-3 cm primary and positive excisional biopsy of an inguinal node with pathology revealing LVSI, positive surgical margins, and more regional lymph nodes on PET?  

This was done prior to the referral for radiation but there is no role for an excisional biopsy of a lymph node and it can be harmful. It changes lymphatic drainage, shifting it to towards the genitalia and suprapubic area.  Cells in transit to that nodal basin will now try to get to the other ...