How would you manage a woman with recurrent Paget's disease of the vulva, s/p resection, with most recent pathology showing multiple foci of early invasion?

Margins negative. Discussion included adjuvant RT versus observation and/or repeat resection with recurrence.

Answer from: Radiation Oncologist at Community Practice

I would consider assessing for sentinel node because of invasion. Adjuvant RT, if margin is close and/or positive only.