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?

I would consider imaging of the regional node basin (axilla) first.

If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases.

If there was distant metastasis, I would probably refer for systemic therapy.

If there was no distant metastasis, ...